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Wheelchair users are nearly 3 times more likely than individuals who do not rely on a wheelchair for mobility to experience hospital readmission following total shoulder arthroplasty (TSA), according to a study from researchers at UT Southwestern Medical Center in Dallas, Texas.

The findings, published in the Journal of Clinical Medicine, highlight the importance of comprehensive preoperative counseling and risk assessment for patients who use wheelchairs.

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“The implications of this research are far-reaching, as it directly impacts a growing population of individuals who rely on wheelchairs for mobility,” said lead researcher Yen-Sheng Lin, PhD, Assistant Professor of Orthopaedic Surgery and Physical Medicine & Rehabilitation at UT Southwestern.

In addition, Dr. Lin and his colleagues found significant differences in the rates of preoperative comorbidities and postoperative complications that can contribute to readmission between wheelchair users and non-users.

Assessing Outcomes at 1 Year

Using the PearlDiver Mariner national administrative database, the researchers identified more than 72,000 patients diagnosed with a rotator cuff tear who underwent TSA between 2010 and 2020. From this group, they created 2 matched cohorts of 869 patients each: wheelchair users and non-wheelchair users.

The researchers compared 1-year outcomes between the groups, such as:

• Comorbidity rates
• Complication rates
• Readmission rates

The study found that common comorbidities were more prevalent in wheelchair users and placed them at greater risk of complications and readmission. Among the preoperative comorbidities, wheelchair users had:

• Nearly 3 times the rate of anemia and ischemic heart disease
• Twice the rate of pulmonary heart disease, myocardial infarction, chronic kidney disease, rheumatoid arthritis, and previous arrhythmias.

The cohorts also had different postoperative complications related to readmission:

• The leading causes of readmission for non-wheelchair users were dislocation and infection.
• The leading causes of readmission for wheelchair users were urinary tract infections, acute kidney injury, and wound disruptions.

The researchers found that wheelchair users were:

• Nearly 4 times more likely to have acute kidney injury
• More than 3 times more likely to develop pneumonia
• Nearly 3 times more likely to have a urinary tract infection

Need for a Tailored Approach

By identifying and addressing the unique challenges wheelchair users face following TSA, health care providers can work toward improving patient outcomes and enhancing quality of life.

“Our research findings have illuminated critical disparities in surgical outcomes for wheelchair users undergoing total shoulder arthroplasty,” Dr. Lin said. “These insights emphasize the need for tailored preoperative assessments, specialized postoperative care, and informed decision-making discussions for this patient population.”

The findings build on Dr. Lin’s ongoing research to better understand secondary complications among individuals with disabilities and to develop novel diagnostic tools for early detection of debilitating processes, reducing the negative impacts of neurologic and musculoskeletal disorders.

Source

Prabhu K, Nasr AJ, Kasitinon D, Cabrera A, Lin Y-S. Perioperative outcomes, comorbidities, and complications following total shoulder arthroplasty in wheelchair users: a retrospective cohort analysis of a nationwide database. J Clin Med. 2023 Sep 6;12(18):5799. doi: 10.3390/jcm12185799.