PROGNOSTIC FACTORS (COMORBIDITIES)

There is a growing body of literature examining the role comorbidities play in post-operative outcomes in shoulder arthroplasty, although it should be noted there is variability in some of the results.  Two high quality studies (Bernstein 2017 and Chalmers 2014) showed that patients with medical comorbidities were at increased risk for complications and hospital re-admission. 

One high quality study (Chalmers et al) noted significantly higher Charlson Comorbidity Index (CCI) scores in those with post-operative complications, both in overall complications and those deemed to be surgical, although it should be noted the majority of complications were classified as “minor” in this study.  Another high-quality study (Bernstein et al) demonstrated that elevated BUN and creatinine were associated with adverse events in TSA, while elevated BUN, elevated creatinine, low platelets, and hypertension requiring medications was associated with TSA and unplanned readmission.  

A moderate quality study (Mahony et al) has suggested that patients with diabetes do not show as much improvement following anatomic TSA, with the authors noting that patients with diabetes were more likely to undergo further surgery in within two years of shoulder arthroplasty or fail to obtain a minimal clinically important difference in ASES scores. 

Strength of Evidence (evidence quality):  Strong
 

Benefits & Harms:  

As the demand for shoulder arthroplasty increases, it is imperative surgeons understand those patients who will likely best succeed after shoulder arthroplasty and have the fewest complications and readmissions.  No harm would come to patients by taking into account these risk factors. 
 

Cost Effectiveness/Resource Utilization: 

This information allows surgeons to stratify which patients will do best with surgery, potentially reducing revision rates and readmissions following shoulder arthroplasty. 

Future Research: 

Future research is needed to better clarify these risk factors and to determine if outcomes following shoulder arthroplasty can be more accurately predicted.