Perioperative complications after total shoulder arthroplasty in patients with neurological disorders

Abstract

BackgroundTotal shoulder arthroplasty (TSA) is an effective procedure to treat end stage osteoarthritis of the shoulder. Outcomes in patients with neurologic disorders are not well documented. Previous studies have shown that TSA in patients with Parkinson’s disease was successful in alleviation of pain, but the overall shoulder function results were poor. We would like to extend this to include more neurologic symptoms. The purpose of this study is to determine the perioperative and the early postoperative outcomes in patients with neurologic disorders undergoing TSA. MethodsThe Nationwide Readmission Database was used to identify all available primary anatomic TSA (aTSA) and reverse TSA (rTSA) occurring the US from 2011 to 2019 resulting in a total of 428,761 cases of TSA, with 209,789 being aTSA and 218,972 being rTSA. Relevant ICD9 and ICD10 codes identified 3602 (0.8%) patients to have at least 1 neurological disease. Both one way analysis of variance and Chi-squared analyses were used for demographic and comorbidity comparisons. For outcomes analyses, a Chi-squared/Fisher’s Exact Test and binary logistic regression were used, which accounted for patient age, sex, primary payer, and Charlson-Deyo comorbidity index. Fisher’s Exact Test was used to confirm significance in all low sample size parameters. ResultsSignificant differences in several demographic categories were found between patients with and without neurological disorders receiving TSA including age (P < .001), sex (P < .001), zip-code income quartile distribution (P < .001), and the primary payer distribution (P < .001). At 180 days, the presence of a neurological condition was significantly predictive of higher rates of extended hospital stay (aTSA: P < .001, rTSA: P < .001) and non–home discharge following both aTSA and rTSA (aTSA: P < .001, rTSA: <0.001). The presence of a neurologic condition was predictive of significantly higher 180-day all-cause complication (P < .001) and mortality rates (P < .001) in patients undergoing rTSA, however this was not seen in those undergoing aTSA. Regarding perioperative complications, in patients undergoing aTSA and rTSA the presence of a neurological condition was significantly predictive of increased complication rates. ConclusionThis study demonstrates that patients with neurologic disorders undergoing TSA are at increased risk for perioperative complications, extended hospital stay, non–home discharge, and mortality out to 180 days. This information is helpful for both patients and surgeons when making an informed decision regarding TSA. Identifying patients with preexisting neurologic disorders before TSA can assist in tailoring preoperative and postoperative management of these patients to improve both short-term and long-term outcomes.