Sex-related differences in PROMs prior to the outcome: comparison of preoperative PROMIS physical function scores in female vs. male patients undergoing shoulder arthroplasty

Abstract

Patient-reported outcome measures (PROMs) are increasingly used to evaluate outcomes in patients undergoing shoulder arthroplasty. The Patient-Reported Outcome Measures Information System (PROMIS) is popular due to low cost and question burden. Females have been reported to have lower postoperative PROMIS scores after shoulder surgery, but studies have not focused on a dedicated cohort of shoulder arthroplasty patients or examined upstream differences in preoperative scores. This study aimed to characterize sex differences in baseline PROMIS scores among anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (rTSA) patients. Data were collected over a 9-month period. Demographics, Charlson Comorbidity Index (CCI), smoking status, BMI, American Shoulder and Elbow Surgeons (ASES) scores, PROMIS Pain, Physical Function (PF), Upper Extremity, Depression, and Anxiety scores, as well as Single Assessment Numeric Evaluation (SANE) scores were collected. Student t-tests were performed to determine correlation with baseline PROMs. A minimal clinically important difference (MCID) of 4 was used to determine if a PROMIS score difference between groups was clinically important. Significance was set as P<.05. A total of 88 females (34 TSAs 54 rTSA) and 99 males (35 TSA, 64 rTSA) were enrolled. Only sex showed a correlation with preoperative PROMIS score. In rTSA patients, females had significantly lower preoperative PROMIS PF scores (P<.05). Among females undergoing TSA vs. rTSA, lower preoperative PROMIS PF scores were found in rTSA (P<.05). These differences exceeded the MCID of 4. The same difference was not found in men undergoing TSA vs. rTSA. Preoperative sex-based differences in PROMIS scores are underappreciated in the shoulder arthroplasty literature. This is the largest study to date focusing on sex-based differences among a dedicated cohort of TSA and rTSA patients, showing a difference in baseline PROMIS scores between males and females above the MCID. These findings suggest that PROMIS scores are affected by sex-based baseline differences in rTSA patients. Further study should investigate sex-based differences in baseline scores to determine their effects on ultimate outcome.