Outcomes of renal failure and dialysis patients undergoing anatomic and reverse shoulder arthroplasty
Background: As anatomic and reverse shoulder arthroplasty incidence increases and outcomes improve, those with severe pre-existing comorbidities may be indicated for surgery. Renal failure patients, including those on dialysis, may have systemic physiologic effects impacting their recovery after shoulder arthroplasty. We hypothesized that renal failure patients would have worse near-term outcomes and increased overall revision rates. Methods: An institutional cohort of 1773 anatomic and reverse shoulder arthroplasty cases performed between July 2013 and May 2019 was retrospectively reviewed for the presence of renal failure as defined by the Elixhauser comorbidity index. This cohort was also reviewed for patients on preoperative dialysis. Near-term outcomes were compared, including inpatient length of stay (LOS), unplanned 90-day readmission, and discharge to a rehabilitation or skilled nursing facility (SNF). Revision status and indication were collected for all renal failure patients, including those having a minimum 1-year and 2-year clinical follow-up, and these outcomes were tested for comparative significance (P < .05) with chi-square tests. Results: One hundred fifty-nine patients were positive for renal failure at the time of surgery (62% reverses, P < .0001), 6 of which were already on dialysis. Sixty-two patients had minimum 1-year clinical follow-up (mean overall follow-up: 1.0 years). Dialysis patients experienced longer inpatient LOS relative to nondialysis renal failure patients (3.2 vs. 2.5 days, P = .0112), and renal failure patients overall had a longer LOS relative to non–renal failure patients (2.6 vs. 2.1 days, P < .0001). Ninety-day readmission rates and SNF/rehab utilization were higher in dialysis patients and renal failure patients overall. While readmissions trended toward significance, SNF rates reached statistical significance (17.0% vs. 10.5%, P = .0125). Postacute care utilization was related to stage of renal failure (P = .03442), inpatient LOS trended toward significance, and revision status, and unplanned 90-day readmission was not related to the stage of renal failure. Eleven revisions (6.9%) were observed in the renal failure cohort, more frequently in dialysis patients (50.0% vs. 5.2%, P < .0001). The overall 2-year survival on Kaplan-Meier analysis was 87%. Conclusion: Renal failure patients (especially those on dialysis) have relatively poor 2-year survival rates, and although many still benefit from shoulder arthroplasty, they should be counseled preoperatively regarding elevated risks, including higher revision rates, postacute care utilization, possibly higher 90-day readmission rates, and longer inpatient LOS. Of note, complications observed in our cohort were primarily related to instability or subscapularis insufficiency rather than infection.
Boadi, PJ; Goltz, DE; Wickman, JR; Levin, JM; Lassiter, T; Klifto, CS; Anakwenze, O
Electronic International Standard Serial Number (EISSN)
International Standard Serial Number (ISSN)
Digital Object Identifier (DOI)