Poster 23: Shoulder Arthroplasty in Patients with Parkinson’s Disease: Analysis of Major Complications,Hospitalization Cost,Discharge Disposition,and 30-Day Readmission Rates

Abstract

Objectives:

Parkinson’s disease (PD) is the most common neurodegenerative movement disorder, affecting 1% of people over age 60. Since exercise is one of the few modifiable factors that can slow PD progression, evaluating the complications of mobility-restoring surgeries is critical. While increased medical complications after total hip and knee arthroplasty have been described, the risk profile for PD patients undergoing elective total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) remains poorly defined. As such, we aimed to examine overall inpatient morbidity for PD patients undergoing shoulder arthroplasty. We secondarily aimed to characterize duration of hospitalization, hospital-related expenditures, discharge disposition, and 30-day readmission rates.

Methods:

A retrospective review using the Nationwide Readmissions Database was performed. All patients ≥18 years of age who underwent TSA for glenohumeral osteoarthritis (OA) or RTSA for rotator cuff arthropathy from 2016-2021 were included. Patients who underwent hemiarthroplasty for any indication and those who underwent RTSA for traumatic etiologies were excluded. Patients were then stratified into PD and non-PD cohorts. Multivariable models were built to evaluate the independent association of PD with key study endpoints. The primary outcome of interest was in-hospital morbidity in the acute postoperative period. Complications were categorized as cardiac, infectious, renal, respiratory, and need for blood transfusion. The secondary outcomes of interest included duration of hospitalization, expenditures, discharge to non-home facilities, and readmission within 30 days of surgery.

Results:

Of 532,862 patients undergoing shoulder arthroplasty, 4,848 (0.9%) presented with PD [Table 1]. On average, the PD cohort was older (73 [68-78] vs 70 years [64-76], p<0.001), of a higher Elixhauser comorbidity index (3 [2-4] vs 2 [1-3], p<0.001), and more commonly male (54.8 vs 45.5%, p<0.001). The PD group faced a higher incidence of major inpatient morbidity, relative to Non-PD (5.2 vs 2.7%, p<0.001) [Table 2]. Following comprehensive risk-adjustment, PD remained associated with significantly increased odds of infection (Adjusted Odds Ratio [AOR] 2.09, 95% Confidence Interval [CI] 1.55-2.82) and need for blood transfusion (AOR 2.05, CI 1.53-2.73). However, the two groups faced similar likelihood of cardiac (AOR 0.65, CI 0.26-1.66), respiratory (AOR 0.91, CI 0.55-1.51), and renal complications (AOR 0.79, CI 0.57-1.10). Considering resource utilization, PD patients experienced longer duration of hospitalization (β+0.71, CI 0.58-0.84) and a $1,100 increase in per-patient costs (CI $740-1480). Additionally, PD patients were more likely to experience non-home discharge (AOR 3.47, CI 3.08-3.90), as well as non-elective readmission within 30-days of discharge (AOR 1.42, CI 1.15-1.76).

Conclusions:

Elective shoulder arthroplasty is generally safe for patients with PD; however, they have a distinct risk profile compared to non-PD patients. Patients with PD experience higher rates of major inpatient morbidity, including infection and blood transfusion requirement, along with longer hospitalizations and increased hospital expenditures. PD patients are also nearly 3.5 times more likely to require non-home discharge and 1.5 times more likely to experience readmission within 30 days of surgery. While outpatient shoulder arthroplasty is associated with excellent outcomes, careful patient selection is critical. For patients with PD, performing elective shoulder arthroplasty in the inpatient setting may be more appropriate.