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Perioperative complications and outcomes in patients with paraplegia following anatomic and reverse total shoulder arthroplasty

Abstract Background Patients with lower extremity paraplegia utilize their upper extremities for mobilization and propulsion, which can lead to painful shoulder degeneration. Anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA) are utilized for patients with paraplegia in an attempt to decrease pain and increase mobility and function of the shoulder joint. The optimal treatment and associated risks of shoulder arthroplasty surgery in patients with paraplegia are unknown. The purpose of this study is to evaluate the perioperative outcomes, length of hospital stay, and readmissions in patients with paraplegia compared to a control group without paraplegia who underwent aTSA and rTSA. Methods The United States Nationwide Readmission Database (NRD) was utilized for this study. To ensure that the perioperative outcomes were attributable to the total shoulder arthroplasty (TSA), patients were excluded if they had any additional invasive procedure(s) during the same hospitalization as the original TSA as long as the procedure was not an adverse outcome of interest. Seventy-nine patients with paraplegia who underwent a TSA were isolated and matched to controls without paraplegia based on arthroplasty type (aTSA vs. rTSA), sex, age, obesity status, insurance type, and median household income. Comparative differences in patient demographics, comorbidities, perioperative complications, length of stay and readmission rates were analyzed. Results Patients with paraplegia undergoing TSA had an increased prevalence of the following preoperative comorbidities: deficiency anemia (P Conclusion TSA successfully relieves shoulder pain and addresses pathology in patients with paraplegia, however this study demonstrates that patients with paraplegia undergoing a TSA experience higher medical complication rates in the perioperative period, a longer hospital stay, and higher readmission rates following discharge compared to their able-bodied matched controls. These findings highlight the importance of providing special consideration for patients with paraplegia when opting for surgical interventions. Level of Evidence : Level III; Retrospective Cohort; Treatment Study