Delayed Reverse Shoulder Arthroplasty for the Primary Treatm
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Reverse total shoulder arthroplasty (rTSA) is gaining popularity as a treatment option for proximal humeral fractures in elderly patients. This study compared the rates of revision and complication, and surgery day cost of treatment between acute and delayed primary rTSA patients.

Elderly patients with proximal humeral fracture who underwent primary rTSA within a year of fracture were identified. Patients were separated into acute (less than 4 weeks) or delayed (more than 4 weeks) cohorts based on the timing of rTSA.

The univariate 1-year rates of revision and complication and surgery day cost of treatment were assessed. Multivariate logistic regression analysis was conducted, accounting for the factors of age, sex, obesity, diabetes comorbidity, and tobacco use.

--4245 acute and 892 delayed primary rTSA patients were identified.

--Acute rTSA was associated with a higher surgery day cost. Delayed rTSA resulted in a higher 1-year revision rate (acute 1.7%, delayed 4.5%) and surgical complication rates of dislocation (acute 2.8%, delayed 6.1%) and mechanical complications (acute 1.9%, delayed 3.4%).

--Multivariate analysis identified delayed primary treatment as independently associated with increased risk of revision (odds ratio: 2.29) and dislocation (OR: 2.05).

In conclusion, relative to acute primary rTSA, delayed primary rTSA was correlated with higher short-term rates of revision and dislocation. These findings indicate that delaying rTSA, whether due to nonsurgical care or a lack of access by patients, may result in increased complication and the need for additional surgery.