From the Pritzker School of Medicine at The University of Chicago, Chicago, IL (Seidel and Bhattacharjee), NorthShore University HealthSystem, Evanston, IL (Koh), and the Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL (Strelzow and Shi).
J Am Acad Orthop Surg. 2021 Oct 1;29(19):832-839. doi: 10.5435/JAAOS-D-20-01375.
Reverse total shoulder arthroplasty (rTSA) is gaining popularity as a treatment option for proximal humeral fractures in elderly patients. The impact of surgical timing on outcomes of primary rTSA is unclear. This study compared the rates of revision and complication, and surgery day cost of treatment between acute and delayed primary rTSA patients.
Elderly patients with proximal humeral fracture who underwent primary rTSA within a year of fracture were identified in a national insurance database from 2005 to 2014. Patients were separated into acute (<4 weeks) or delayed (>4 weeks) cohorts based on the timing of rTSA. The univariate 1-year rates of revision and complication and surgery day cost of treatment were assessed. Multivariate logistic regression analysis was conducted, accounting for the factors of age, sex, obesity, diabetes comorbidity, and tobacco use.
Four thousand two hundred forty-five (82.6%) acute and 892 (17.4%) delayed primary rTSA patients were identified. Acute rTSA was associated with a higher surgery day cost (acute $15,770 ± $8,383, delayed $14,586 ± $7,271; P < 0.001). Delayed rTSA resulted in a higher 1-year revision rate (acute 1.7%, delayed 4.5%; P < 0.001) and surgical complication rates of dislocation (acute 2.8%, delayed 6.1%; P < 0.001) and mechanical complications (acute 1.9%, delayed 3.4%; P = 0.007). Multivariate analysis identified delayed primary treatment as independently associated with increased risk of revision (odds ratio: 2.29, 95% confidence interval 1.53 to 3.40; P < 0.001) and dislocation (OR: 2.05, 95% confidence interval 1.45 to 2.86; P < 0.001).
Delayed primary rTSA was associated with higher short-term rates of revision and dislocation compared with acute primary rTSA. Our results suggest that delaying rTSA, whether because of attempted nonsurgical treatment or patients' lack of access, may result in increased complication and additional surgery.
Level III.
反向全肩关节置换术（rTSA）作为老年患者肱骨近端骨折的治疗选择越来越受欢迎。手术时机对原发性 rTSA 结果的影响尚不清楚。本研究比较了急性和延迟性原发性 rTSA 患者的翻修率和并发症发生率以及治疗的手术日费用。
从 2005 年至 2014 年，在全国性保险数据库中确定了在骨折后一年内接受原发性 rTSA 的老年肱骨近端骨折患者。根据 rTSA 的时间将患者分为急性（<4 周）或延迟（>4 周）队列。评估了 1 年时的翻修率和并发症发生率以及治疗的手术日费用。进行了多变量逻辑回归分析，考虑了年龄、性别、肥胖、糖尿病合并症和吸烟等因素。
确定了 4245 例（82.6%）急性和 892 例（17.4%）延迟性原发性 rTSA 患者。急性 rTSA 的手术日费用较高（急性 rTSA：$15770±$8383，延迟 rTSA：$14586±$7271；P<0.001）。延迟性 rTSA 导致 1 年翻修率较高（急性 rTSA：1.7%，延迟 rTSA：4.5%；P<0.001）和脱位（急性 rTSA：2.8%，延迟 rTSA：6.1%；P<0.001）和机械并发症（急性 rTSA：1.9%，延迟 rTSA：3.4%；P=0.007）的发生率较高。多变量分析确定延迟性原发性治疗与增加的翻修风险（优势比：2.29，95%置信区间 1.53 至 3.40；P<0.001）和脱位（OR：2.05，95%置信区间 1.45 至 2.86；P<0.001）独立相关。
与急性原发性 rTSA 相比，延迟性原发性 rTSA 与较高的短期翻修和脱位率相关。我们的结果表明，延迟 rTSA，无论是因为试图进行非手术治疗还是患者无法获得治疗，都可能导致并发症增加和额外手术。
III 级。
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