Ling Kenny, Butsenko Dmitriy, Gallagher James, Loyst Rachel, Liu Steven H, Komatsu David E, Wang Edward D
Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA.
Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
JSES Int. 2025 Jan 2;9(3):756-760. doi: 10.1016/j.jseint.2024.11.023. eCollection 2025 May.
Total shoulder arthroplasty is an increasingly popular surgical treatment for degenerative diseases of the shoulder. The expansion of indications for reverse total shoulder arthroplasty (rTSA) to include proximal humerus (PHFs) fractures has led 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.
The authors queried the American College of Surgeons National Surgical Quality Improvement Program database for all patients who underwent rTSA for 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 rTSA and postoperative complications.
Patient demographics and comorbidities that were significantly associated with admitted inpatient rTSA for PHF were age≥ 75 ( < .001), American Society of Anesthesiologists classification ≥3 ( < .007), congestive heart failure ( = .001), open wound/wound infection ( < .001), bleeding disorders ( < .001), and transfusion prior to surgery ( < .001). Multivariate analysis found admitted inpatient rTSA for PHF to be independently associated with blood transfusions (odds ratio 2.27, 95% confidence interval 1.66-3.09; < .001) and nonhome discharge (odds ratio 2.70, 95% confidence interval 2.16-3.38; < .001).
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 nonhome discharge within the 30-day postoperative period, compared to rTSA performed for PHF in patients presenting from home.
全肩关节置换术是治疗肩部退行性疾病越来越常用的手术方法。反向全肩关节置换术（rTSA）的适应症扩展至包括肱骨近端骨折（PHF），这使得rTSA在住院环境中开展，这可能会限制术前患者优化和管理的时间。本研究的目的是调查对需要术前住院的患者进行rTSA术后30天的并发症。
作者查询了美国外科医师学会国家外科质量改进计划数据库中2015年至2020年间因PHF接受rTSA的所有患者。使用二元逻辑回归比较“住院患者”和“居家患者”队列之间的患者人口统计学和合并症情况。采用多因素逻辑回归，并对所有显著相关的患者人口统计学和合并症进行校正，以确定住院rTSA与术后并发症之间的关联。
与因PHF接受住院rTSA显著相关的患者人口统计学和合并症包括年龄≥75岁（P<0.001）、美国麻醉医师协会分级≥3级（P< .007）、充血性心力衰竭（P = .001）、开放性伤口/伤口感染（P< .001）、出血性疾病（P< .001）以及术前输血（P< .001）。多因素分析发现，因PHF接受住院rTSA与输血独立相关（比值比2.27，95%置信区间1.66 - 3.09；P< .001）以及非居家出院独立相关（比值比2.70，95%置信区间2.16 - 3.38；P< .001）。
住院期间因PHF接受rTSA的患者出血性疾病和术前输血发生率更高。术后，与居家患者接受的PHF的rTSA相比,住院患者接受的PHF的rTSA在术后30天内输血率和非居家出院率更高。
