Shoulder Arthroplasty: Disposition and Perioperative Outcomes in Patients With and Without Rheumatoid Arthritis

Shoulder arthroplasty (SA) is used to treat pain and disability associated with rheumatoid arthritis (RA). Although SA is an effective procedure in patients with RA, more investigation of perioperative outcomes is needed. We conducted a study to compare the perioperative complication rates and demographics of patients with and without RA. Given the potential for anemia of chronic disease and the systemic inflammatory nature of RA, we hypothesized that the perioperative complication profile of RA patients would be worse than that of non-RA patients. Data on SA patients were obtained from the Nationwide Inpatient Sample for the period 2006-2011. Of the 34,970 SA patients identified, 1674 had a primary diagnosis of RA and 33,296 did not. Demographics, hospital disposition factors, and complications were compared using regression analysis. Analyses of 14 different perioperative outcome measures demonstrated no significant difference in any category except blood transfusions; the blood transfusion rate was significantly higher (P < .001) for RA patients (9.00%) than for non-RA patients (6.16%). RA patients had longer hospital length of stay (2.196 vs 2.085 days; P < .001), higher inflation-adjusted charges ($54,284 vs $52,663; P = .018), and lower home discharge rates (63.0% vs 67.6%; P < .001). These results suggest that the complex nature of RA plays a role in perioperative SA outcomes. RA patients' longer hospital stays were not clinically significant. Research on postoperative care, billing practices, and hospital protocols is needed to determine the cause of these outcomes.