LAUSR

BACKGROUND Favorable clinical and functional outcomes can be achieved with reverse shoulder arthroplasty (RSA). Given the expanding utilization of RSA in the United States, understanding the factors that influence both excellent and poor outcomes is increasingly important. METHODS A single-surgeon prospective registry was utilized to identify patients who underwent RSA from 2013 to 2018 with minimum of 2-year follow-up. Excellent postoperative clinical outcome was defined as being within the top quartile for final American Shoulder and Elbow Surgeons (ASES) score. Poor outcome was defined as being in the bottom quartile of ASES score. Logistic regression was used to determine preoperative characteristics associated with both excellent and poor outcomes. RESULTS A total of 338 patients with a mean age of 71.5 years (SD 6.4) met inclusion and exclusion criteria. The average preoperative ASES score for the entire cohort was 35.3 (SD 16.4), which improved to 82.4 (SD 16.1) postoperatively (P < .001). Univariate analysis demonstrated that a diagnosis of primary osteoarthritis (OA), private insurance, and higher preoperative ASES scores were significantly associated with achieving excellent outcomes (P < .01 for all). Variables predictive of poor outcomes were worker's compensation status (P = .03), depression (P =.02), preoperative diagnosis of rotator cuff tear arthropathy (RCA) (P < .01), preoperative opioid use (P <.01), higher number of allergies (P <.01) and prior ipsilateral shoulder surgery (P < .01). Multivariate regression analysis demonstrated that OA (OR 5.6, 95% CI 1.2-26.5, P = .03) and private insurance (OR 2.7 95% CI 1.12-6.5, P = .02) correlated with excellent outcomes, whereas higher number of reported allergies (OR 0.83, 95% CI 0.71-0.97, P = .02), self-reported depression (OR 0.39, 95% CI 0.16-0.99, P =.04), history of prior ipsilateral shoulder surgery (OR 0.36, 95% CI 0.15-0.87, P =.02), and preoperative opioid use (OR 0.26, 95% CI 0.09-0.76, P = .01) were predictive of poor outcomes. CONCLUSIONS A preoperative diagnosis of primary osteoarthritis is the strongest predictor for excellent clinical outcomes following RSA. Patients with increasing number of reported allergies, self-reported depression, a history of prior ipsilateral shoulder surgery, and preoperative opioid use are significantly more likely to achieve poor outcomes after RSA. Given the increasing utilization of RSA, this information is important to appropriately counsel patients regarding postoperative expectations.