The impact of nutritional status on revision total shoulder arthroplasty: perioperative outcomes and complications

Background

As the prevalence of primary total shoulder arthoplasty (TSA) increases in the United States so does the number of revision TSA. Those undergoing primary TSA with lower nutritional status have been shown to have worse outcomes; however, little knowledge exists regarding the effects of malnutrition on outcomes following revision TSA. The purpose of this study is to determine the clinical outcomes and complication rates following revision TSA, as well as the prevalence of diabetes mellitus (DM) in malnourished patients undergoing revision TSA.

Methods

The American College of Surgeons National Surgical Quality Improvement Program Database was queried from 2013 to 2020 and found 783 cases of revision TSA. Albumin was used as a surrogate marker for nutritional status. Patients were stratified into unmatched cohorts of normal (albumin ≥ 3.5 g/dL, n = 700) and low (albumin < 3.5 g/dL, n = 83) nutritional status, as well as by diagnosis of DM. Comparative differences in demographics, comorbidities, length of stay (LOS), readmission, reoperation, and 30-day postoperative complications related to their nutritional status and presence of DM were analyzed using chi-squared tests, independent sample t tests, and multivariate analysis on SPSS.

Results

Patients within the low albumin cohort were more likely to be female (P = .008), increased mean age (P = .018), on dialysis (P = .002), had undergone an emergency procedure (P < .001), classified with a dependent functional status (P < .001), and had a higher American Society of Anesthesiologists classification (P < .001). There was a higher percentage of patients with a DM diagnosis and hypoalbuminemia compared to nondiabetic patients (36.2% vs. 19.4%, P < .001). Compared to the normal albumin cohort, the low albumin cohort was found to have significantly longer LOS (P = .025), increased bleeding/transfusion complications (8.4% vs. 3.3%, P = .021), and increased reoperation rate (8.4% vs. 0.71%, P = .034). No significant difference in readmission was found (P = .226).

Conclusion

Eleven percentage of patients undergoing revision TSA were malnourished and had higher LOS and reoperation rates. Patients with DM had a significantly higher incidence of being malnourished than those without DM. Malnourishment represents a potential modifiable risk factor for patients undergoing revision TSA, and surgeons should screen patients preoperatively, especially those patients with DM.