Total shoulder arthroplasty in patients with a history of cerebrovascular accident: a matched case–control study

Abstract

Background

With increasing survivorship following cerebrovascular accidents (CVAs), more patients with a history of CVA are undergoing total shoulder arthroplasty (TSA). The purpose of this study is to determine the impact of prior CVA on the perioperative outcomes following TSA.

Methods

The Nationwide Readmissions Database was queried from 2010 to 2019 to identify all patients with a history of CVA undergoing TSA. Eight hundred seventeen cases were identified and case matched on a 1:2 ratio for age, sex, obesity status, and year of procedure. Patient demographic characteristics were collected and analyzed for differences between the 2 groups. Data on length of stay, 180-day complications, 180-day readmissions, and 180-day mortality were collected and analyzed for differences between the 2 groups.

Results

Eight hundred seventeen cases of patients with a history of CVA were matched with 1634 patients without a history of CVA undergoing TSA. The average age was 71. Fifty six percent of patients were female, and 23% of patients were obese. Patients with CVA had higher incidence of tobacco use (P < .001), deficiency anemia (P < .001), electrolyte disorders (P < .001), paralysis (P < .001), coagulopathy (P < .001), heart valve disorders (P < .001), history of myocardial infarction (P < .001), and higher rates of chronic diseases, such as hypertension (P < .001), diabetes (P < .001), liver disease (P < .001), congestive heart failure (P < .001), renal failure (P < .001), and peripheral vascular disease (P < .001). Patients with a history of CVA had higher rates of complications, readmissions, and revisions within 180 days (P < .001). One hundred eighty–day mortality was similar between the 2 groups. The average length of stay was 3.2 days in patients with a history of CVA compared to 1.4 days in those without a history of CVA (P < .001).

Conclusion

Patients with a history of CVA have a higher rate of medical comorbidities than those without. These patients have higher rates of complications within 180 days of procedure, 180-day readmissions, and 180-day revisions. One hundred eighty–day mortality was similar between the 2 groups. Surgeons should take care to ensure thorough preoperative optimization and risk discussions to try and minimize postoperative adverse outcomes.