Total shoulder arthroplasty in patients with dementia or mild cognitive impairment
Background: Anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA) reliably alleviate pain and restore shoulder function for a variety of indications. However, these procedures are not well-studied in patients with neurocognitive impairment. Therefore, the purpose...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-01-01
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| Series: | JSES International |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666638323002402 |
| _version_ | 1797345887205195776 |
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| author | Juan Serna, BS Favian Su, MD Drew A. Lansdown, MD Brian T. Feeley, MD C. Benjamin Ma, MD Alan L. Zhang, MD |
| author_facet | Juan Serna, BS Favian Su, MD Drew A. Lansdown, MD Brian T. Feeley, MD C. Benjamin Ma, MD Alan L. Zhang, MD |
| author_sort | Juan Serna, BS |
| collection | DOAJ |
| description | Background: Anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA) reliably alleviate pain and restore shoulder function for a variety of indications. However, these procedures are not well-studied in patients with neurocognitive impairment. Therefore, the purpose of this study was to investigate whether patients with dementia or mild cognitive impairment (MCI) have increased odds of surgical or medical complications following arthroplasty. Methods: The PearlDiver database was queried from 2010 through October 2021 to identify a cohort of patients who underwent either ATSA or RTSA and had a minimum 2-year follow-up. Current Procedural Terminology and International Classification of Diseases codes were used to stratify this cohort into three groups: (1) patients with dementia, (2) patients with MCI, and (3) patients with neither condition. Surgical and medical complication rates were compared among these three groups. Results: The overall prevalence of neurocognitive impairment among patients undergoing total shoulder arthroplasty was 3.0% in a cohort of 92,022 patients. Patients with dementia had increased odds of sustaining a periprosthetic humerus fracture (odds ratio [OR] = 1.46, P < .001), developing prosthesis instability (OR = 1.72, P < .001), and undergoing revision arthroplasty (OR = 1.55, P = .003) after RTSA compared to patients with normal cognition. ATSA patients with dementia did not have an elevated risk of surgical complications or revision. Conversely, RTSA patients with MCI did not have an elevated risk of complications or revision, although ATSA patients with MCI had greater odds of prosthesis instability (OR = 2.51, P = .008). Additionally, patients with neurocognitive impairment had elevated odds of medical complications compared to patients with normal cognition, including acute myocardial infarction and cerebrovascular accident. Conclusion: Compared to patients with normal cognition, RTSA patients with preoperative dementia and ATSA patients with preoperative MCI are at increased risk for surgical complications. Moreover, both ATSA and RTSA patients with either preoperative MCI or dementia are at increased risk for medical complications. As the mean age in the U.S. continues to rise, special attention should be directed towards patients with neurocognitive impairment to minimize postoperative complications aftertotal shoulder arthroplasty, and the risks of this surgery more carefully discussed with patients and their families and caretakers. |
| first_indexed | 2024-03-08T11:25:14Z |
| format | Article |
| id | doaj.art-f2208a22d8ed4bd9a6d62a49f708d379 |
| institution | Directory Open Access Journal |
| issn | 2666-6383 |
| language | English |
| last_indexed | 2024-03-08T11:25:14Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JSES International |
| spelling | doaj.art-f2208a22d8ed4bd9a6d62a49f708d3792024-01-26T05:35:23ZengElsevierJSES International2666-63832024-01-0181159166Total shoulder arthroplasty in patients with dementia or mild cognitive impairmentJuan Serna, BS0Favian Su, MD1Drew A. Lansdown, MD2Brian T. Feeley, MD3C. Benjamin Ma, MD4Alan L. Zhang, MD5Corresponding author: Juan Serna, BS, Orthopaedic Surgery Education Office, University of California, San Francisco, 500 Parnassus Ave, MU-320W, San Francisco, CA 94143, USA.; Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USADepartment of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USADepartment of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USADepartment of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USADepartment of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USADepartment of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USABackground: Anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA) reliably alleviate pain and restore shoulder function for a variety of indications. However, these procedures are not well-studied in patients with neurocognitive impairment. Therefore, the purpose of this study was to investigate whether patients with dementia or mild cognitive impairment (MCI) have increased odds of surgical or medical complications following arthroplasty. Methods: The PearlDiver database was queried from 2010 through October 2021 to identify a cohort of patients who underwent either ATSA or RTSA and had a minimum 2-year follow-up. Current Procedural Terminology and International Classification of Diseases codes were used to stratify this cohort into three groups: (1) patients with dementia, (2) patients with MCI, and (3) patients with neither condition. Surgical and medical complication rates were compared among these three groups. Results: The overall prevalence of neurocognitive impairment among patients undergoing total shoulder arthroplasty was 3.0% in a cohort of 92,022 patients. Patients with dementia had increased odds of sustaining a periprosthetic humerus fracture (odds ratio [OR] = 1.46, P < .001), developing prosthesis instability (OR = 1.72, P < .001), and undergoing revision arthroplasty (OR = 1.55, P = .003) after RTSA compared to patients with normal cognition. ATSA patients with dementia did not have an elevated risk of surgical complications or revision. Conversely, RTSA patients with MCI did not have an elevated risk of complications or revision, although ATSA patients with MCI had greater odds of prosthesis instability (OR = 2.51, P = .008). Additionally, patients with neurocognitive impairment had elevated odds of medical complications compared to patients with normal cognition, including acute myocardial infarction and cerebrovascular accident. Conclusion: Compared to patients with normal cognition, RTSA patients with preoperative dementia and ATSA patients with preoperative MCI are at increased risk for surgical complications. Moreover, both ATSA and RTSA patients with either preoperative MCI or dementia are at increased risk for medical complications. As the mean age in the U.S. continues to rise, special attention should be directed towards patients with neurocognitive impairment to minimize postoperative complications aftertotal shoulder arthroplasty, and the risks of this surgery more carefully discussed with patients and their families and caretakers.http://www.sciencedirect.com/science/article/pii/S2666638323002402Anatomic total shoulder arthroplastyReverse total shoulder arthroplastyDementiaMild cognitive impairmentSurgical complicationsMedical complications |
| spellingShingle | Juan Serna, BS Favian Su, MD Drew A. Lansdown, MD Brian T. Feeley, MD C. Benjamin Ma, MD Alan L. Zhang, MD Total shoulder arthroplasty in patients with dementia or mild cognitive impairment JSES International Anatomic total shoulder arthroplasty Reverse total shoulder arthroplasty Dementia Mild cognitive impairment Surgical complications Medical complications |
| title | Total shoulder arthroplasty in patients with dementia or mild cognitive impairment |
| title_full | Total shoulder arthroplasty in patients with dementia or mild cognitive impairment |
| title_fullStr | Total shoulder arthroplasty in patients with dementia or mild cognitive impairment |
| title_full_unstemmed | Total shoulder arthroplasty in patients with dementia or mild cognitive impairment |
| title_short | Total shoulder arthroplasty in patients with dementia or mild cognitive impairment |
| title_sort | total shoulder arthroplasty in patients with dementia or mild cognitive impairment |
| topic | Anatomic total shoulder arthroplasty Reverse total shoulder arthroplasty Dementia Mild cognitive impairment Surgical complications Medical complications |
| url | http://www.sciencedirect.com/science/article/pii/S2666638323002402 |
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