The relationship between age and short-term complications following reverse total shoulder arthroplasty for proximal humerus fractures

Abstract

Background: Proximal humerus fractures (PHFx) are common orthopedic injuries among the elderly. Although nonoperative management remains the primary treatment modality, more than one-third of PHFx are now treated surgically. Over the past decade, reverse total shoulder arthroplasty (RTSA) has gained popularity as a treatment option for PHFx, both in elderly patients with complex fractures and patients younger than 65 years. While the age range of patients undergoing RTSA for PHFx has expanded, little is known about the impact of age on postoperative complications. The purpose of this study was to examine the relationship between age and 30-day complication rates following RTSA for PHFx. Methods: The National Surgical Quality Improvement Program database was queried for patients who underwent RTSA for PHFx between 2006 and 2018. Patient demographic data, surgical characteristics, and adverse outcomes were extracted. Patients were divided into four cohorts by age (<65, 65-75, 76-85, >85 years), and univariate as well as multivariate analyses were performed. Results: A total of 1099 patients were identified with a mean age of 72.7 years. Overall, 6.73% of patients experienced one or more complications. Mean operative duration decreased with age (135 minutes in the <65 years old cohort vs. 119 minutes in the >85 years old cohort, P < .001), while average hospital stay increased with age (2.8 days in the <65 years old cohort vs. 4.2 days in the >85 years old cohort, P < .001). Neither the overall complication rate nor the mortality rate was significantly different between cohorts. Relative to the <65 years old cohort, perioperative blood transfusion and non-home discharge were significantly more common in the 76-85 years old and >85 years old cohorts. Age >75 years, preoperative dependent functional status, and ASA class 3 or 4 were found to be independent risk factors for perioperative blood transfusion. Age ≥65 years, female gender, congestive heart failure, preoperative dependent functional status, and ASA class 3 or 4 were found to be independent risk factors for non-home discharge. The rate of unplanned hospital readmission was highest in the >85 years old cohort (17.65%), though this difference did not reach statistical significance. Conclusions: While RTSA appears to be a safe treatment option for PHFx in appropriately selected elderly patients, a longer hospitalization and more frequent non-home discharge should be anticipated. Additionally, elderly patients should be closely monitored for postoperative anemia. Level of evidence: Level III; Retrospective Cohort Study