Humerus Fractures : Reverse Shoulder – Complications

Preoperative Hospital Admission and Complications Following Reverse Total Shoulder Arthroplasty For Proximal Humerus Fractures, specifically focusing on reverse shoulder replacement procedures.

 Ling, Butsenko, Gallagher, Loyst, Liu, Komatsu, Wang

https://doi.org/10.1016/j.jseint.2024.11.023(opens in a new tab)Get rights and content(opens in a new tab)

ABSTRACT

Background

Total shoulder arthroplasty (TSA) is an increasingly popular surgical treatment for degenerative diseases of the shoulder. The expansion of indications for reverse TSA (rTSA) to include proximal humerus fractures leads to rTSA being performed in the inpatient setting, which potentially limits the time for preoperative patient optimization and management. The purpose of this study was to investigate the 30-day postoperative complications associated with rTSA performed on patients requiring preoperative inpatient admission.

Methods

The authors queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for all patients who underwent rTSA for proximal humerus fracture (PHF) between 2015 and 2020. Patient demographics and comorbidities were compared between “admitted inpatient” and “from home” cohorts using bivariate logistic regression. Multivariate logistic regression, adjusted for all significantly associated patient demographics and comorbidities, was used to identify associations between admitted inpatient reverse shoulder replacement and postoperative complications.

Results

Patient demographics and comorbidities that were significantly associated with admitted inpatient rTSA for PHF are age ≥ 75 (p < 0.001), ASA classification ≥ 3 (p < 0.007), congestive heart failure (p = 0.001), open wound/wound infection (p < 0.001), bleeding disorders (p < 0.001), and transfusion prior to surgery (p < 0.001). Multivariate analysis found admitted inpatient rTSA for PHF to be independently associated with blood transfusions (OR 2.27, 95% CI 1.66-3.09; p < 0.001) and non-home discharge (OR 2.70, 95% CI 2.16-3.38; p < 0.001).

Conclusion

Patients who underwent inpatient rTSA for PHF while admitted had higher rates of bleeding disorders and preoperative transfusion. Postoperatively, inpatient rTSA for PHF was independently associated with higher rates of blood transfusions and non-home discharge within the 30-day postoperative period, compared to rTSA performed for PHF in patients presenting from home.

My Opinion

When possible, and always with patient safety in mind, a patient undergoing treatment for a proximal humeral fracture (fixation / shoulder replacement) should spend as little time in a hospital environment as possible. The logic behind this thought process is that hospitals are a congregation of illness and treaments. If a non-infected patient spends alot of time in such an environment, the risk of adverse outcomes (infection etc) increases. In order to minimize the time the patient has to spend in the hospital (optimally as a day-case procedure) the medical conditions have to be expeditiously controlled and managed, the reverse shoulder replacement surgery should be performed with minimal iatrogenic injury, and a pre- and post-op care team with expertise.