Elective Total Shoulder Arthroplasty in Octogenarians: A Safe Procedure

Area of Science:

• Orthopedic Surgery
• Geriatric Medicine
• Patient Safety

Background:

• Limited research exists on the perioperative outcomes of total shoulder arthroplasty (TSA) in octogenarians (≥80 years).
• The aging population necessitates understanding surgical risks in older adults undergoing TSA.
• This study addresses the gap by comparing TSA outcomes across different age groups.

Purpose of the Study:

• To compare perioperative complications and outcomes of primary TSA in octogenarians versus younger patient groups.
• To identify risk factors and reasons for readmission in octogenarian TSA patients.
• To inform clinical decision-making for TSA in the elderly population.

Main Methods:

• Utilized the National Surgical Quality Improvement Program database (2005-2015).
• Stratified 6,062 primary TSA patients into three age groups: <70, 70-79, and ≥80 years.
• Performed propensity score-matched comparisons for outcomes including length of stay, complications, and readmissions.

Main Results:

• Octogenarians (n=900) experienced significantly higher readmission rates (4.2%), pneumonia (1.1%), and UTI (1.8%) compared to the <70 group.
• No significant differences in 30-day perioperative complications were found between octogenarians and the 70-79 group.
• Octogenarians had a longer hospital stay (0.6 days longer than <70; 0.4 days longer than 70-79).

Conclusions:

• Primary TSA is a safe option for octogenarians, with only mildly increased morbidities.
• Higher readmission rates in octogenarians suggest a need for enhanced preoperative optimization.
• Improved post-discharge care strategies are recommended to mitigate readmission risks in elderly TSA patients.