Patients Experiencing Homelessness Have Higher Complication Rates After Total Shoulder Arthroplasty

Patients experiencing homelessness (PEH) face substantial barriers to healthcare access and continuity, which may affect outcomes following total shoulder arthroplasty (TSA). While TSA is an effective treatment for end-stage glenohumeral arthritis, limited research has evaluated postoperative outcomes in PEH. The purpose of this study was to evaluate postoperative outcomes following total shoulder arthroplasty in patients experiencing homelessness.

We performed a retrospective cohort study using a de-identified electronic health record to identify patients undergoing TSA and stratified them based on housing status. Propensity score matching was conducted between groups. Primary outcomes included 90-day medical complications and 1-year surgical complications. A secondary analysis assessed postoperative opioid prescription patterns at multiple timepoints.

At 90 days postoperatively, patients experiencing homelessness (n=715) exhibited significantly higher rates of sepsis (OR 3.00; 95% CI 1.68-5.36; P < 0.001), surgical site infection (OR 2.19; 95% CI 1.15-4.17; P = 0.014), pneumonia (OR 1.86; 95% CI 1.08-3.19; P = 0.024), acute kidney injury (OR 2.10; 95% CI 1.41-3.11; P < 0.001), and emergency department utilization (OR 3.42; 95% CI 2.67-4.38; P < 0.001). At one-year, prosthetic joint infection was significantly higher in PEH (OR 2.01; 95% CI 1.16-3.48; P = 0.011). PEH were also less likely to receive opioid prescriptions at all timepoints, with significantly reduced odds at 24 h postoperatively (OR 0.59; 95% CI 0.47-0.73; P < 0.0001).

Patients experiencing homelessness undergoing TSA have higher rates of postoperative complications. These findings highlight the importance of perioperative identification and targeted support for vulnerable populations to reduce adverse outcomes.

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