Wheelchair users at higher risk of complications, readmissions after total shoulder arthroplasty

In the US, about 3.3 million individuals use an electric or manual wheelchair as their primary means of mobility, and nearly 2 million users are above the age of 65. The prevalence of shoulder pathologies is high in this wheelchair-dependent population, with 33–62% of wheelchair users reporting decreased quality of life and compromised independent living.

The currently available literature delineates the benefits and risks of surgical techniques for managing shoulder pathologies. According to the authors, no study has investigated complications following TSA in wheelchair users. To fill this knowledge gap, Kevin Prabhu, UT Southwestern Medical Center, Medical School, Dallas, TX, USA, and colleagues aimed to assess the 1-year preoperative comorbidities, readmission rates, and postoperative complications after TSA among wheelchair users.

They hypothesized that wheelchair use would be tied to increased rates of postoperative complications and preoperative comorbidities within one year of TSA compared to patients who did not use wheelchairs. They also hypothesized that wheelchair users were more likely to be readmitted postoperatively after TSA compared to non-wheelchair users.

The study included 72,108 patients who underwent TSA with a concurrent diagnosis of a rotator cuff tear, using the PearlDiver Mariner national administrative database. Two matched cohorts were created: one of wheelchair users and one of non-wheelchair users.

Owing to limitations within PearlDiver, one-year outcomes, including complication rates and comorbidity and readmission statistics, were compared between the two cohorts. Each matched cohort comprising 869 patients underwent TSA with a concurrent diagnosis of a rotator cuff tear.

The researchers reported the following findings:

• The rate of readmission in wheelchair users was greater than in non-wheelchair users (24.05% versus 9.55%, OR: 3.00).
• Patients in the wheelchair cohort exhibited higher rates of complications and comorbidities.
• Among the most likely to be readmitted after TSA were patients with osteoarthritis, rheumatoid arthritis, pulmonary heart disease, and hypertension.
• Significant differences in surgical outcomes existed between wheelchair and non-wheelchair users in terms of postoperative complications, preoperative comorbidities, and readmission rates.

"Our results demonstrate that wheelchair users are at risk of a higher complication profile after TSA compared to non-wheelchair users," the researchers wrote.

"Therefore, the findings suggest that patients should be adequately counselled on the benefits and risks before electing to pursue surgical intervention. Specifically, an important consideration during pre-surgical counselling is adequate identification of the optimal length of rehabilitation and immobilization during the postoperative period."

"Such individualized care would aid in clear communication between the rehabilitation team, surgical team, patient, and the patient’s family, therefore conceivably minimizing postoperative complications," they concluded.

Reference:

Prabhu, K., Nasr, A. J., Kasitinon, D., Cabrera, A., & Lin, Y. (2022). Perioperative Outcomes, Comorbidities, and Complications following Total Shoulder Arthroplasty in Wheelchair Users: A Retrospective Cohort Analysis of a Nationwide Database. Journal of Clinical Medicine, 12(18), 5799. https://doi.org/10.3390/jcm12185799