Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: Patient demographics and comorbidities that were significantly associated with admitted inpatient rTSA for PHF were age≥ 75 (P < .001), American Society of Anesthesiologists classification ≥3 (P < .007), congestive heart failure (P = .001), open wound/wound infection (P < .001), bleeding disorders (P < .001), and transfusion prior to surgery (P < .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; P < .001) and nonhome discharge (odds ratio 2.70, 95% confidence interval 2.16-3.38; P < .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 nonhome discharge within the 30-day postoperative period, compared to rTSA performed for PHF in patients presenting from home.