Prabhu Kevin, Nasr Andrew J, Kasitinon Donald, Cabrera Alison, Lin Yen-Sheng
UT Southwestern Medical Center, Medical School, Dallas, TX 75390, USA.
Department of Applied Clinical Research, University of Texas Southwestern, Dallas, TX 75390, USA.
J Clin Med. 2023 Sep 6;12(18):5799. doi: 10.3390/jcm12185799.
Impaired shoulder function hinders the ability of wheelchair users to maintain independence. The current state of the literature delineates the risks and benefits of surgical techniques for the management of shoulder pathologies. To the best of our knowledge, there is no study that has investigated complications following total shoulder arthroplasty (TSA) in wheelchair users. Utilizing the PearlDiver Mariner national administrative database, 72,108 patients were identified who underwent TSA with a concurrent diagnosis of a rotator cuff tear. Two matched cohorts, one of wheelchair users and one of non-wheelchair users, were created. Due to limitations within PearlDiver, one-year outcomes, including comorbidity and complication rates and readmission statistics, were compared between the two cohorts. Each matched cohort of 869 patients underwent TSA with a concurrent diagnosis of a rotator cuff tear. The rate of readmission in wheelchair users was greater than in non-wheelchair users (24.05% vs. 9.55%, OR: 3.00, CI: 2.279, 3.946). Patients in the wheelchair cohort exhibited higher rates of complications and comorbidities ( < 0.001). Among the most likely to be readmitted after TSA were patients with osteoarthritis, pulmonary heart disease, rheumatoid arthritis, and hypertension ( < 0.05). Significant differences in surgical outcomes existed between wheelchair and non-wheelchair users in terms of preoperative comorbidities, postoperative complications, and readmission rates.
肩部功能受损会妨碍轮椅使用者维持独立的能力。目前的文献状况阐述了用于治疗肩部疾病的手术技术的风险和益处。据我们所知，尚无研究调查过轮椅使用者全肩关节置换术（TSA）后的并发症。利用PearlDiver Mariner国家行政数据库，确定了72108例同时诊断为肩袖撕裂并接受TSA的患者。创建了两个匹配队列，一个是轮椅使用者队列，另一个是非轮椅使用者队列。由于PearlDiver存在局限性，对两个队列之间的一年期结局进行了比较，包括合并症和并发症发生率以及再入院统计数据。每个由869例患者组成的匹配队列均接受了同时诊断为肩袖撕裂的TSA。轮椅使用者的再入院率高于非轮椅使用者（24.05%对9.55%，OR：3.00，CI：2.279，3.946）。轮椅队列中的患者并发症和合并症发生率更高（<0.001）。TSA后最有可能再次入院的患者包括骨关节炎、肺心病、类风湿关节炎和高血压患者（<0.05）。在术前合并症、术后并发症和再入院率方面，轮椅使用者和非轮椅使用者之间的手术结局存在显著差异。
