2021 ISAKOS Biennial Congress ePoster
Clinical And Patient-Reported Outcomes Of Reverse Shoulder Arthroplasty In Patients Receiving Social Security Disability Insurance Or Workers’ Compensation
Prashant Meshram, MBBS, MS, DNB (Ortho), Dubai, Dubai UNITED ARAB EMIRATES
Stephen C. Weber, MD, San Diego, CA UNITED STATES
Matthew Binkley, Buffalo, NY UNITED STATES
Gary W. Pushkin, MD UNITED STATES
Uma Srikumaran, MD, MBA, MPH, Columbia, MD UNITED STATES
Edward G. McFarland, Lutherville, MD UNITED STATES
Johns Hopkins Medical Institute, Baltimore, MD, UNITED STATES
FDA Status Cleared
Summary
Among RSA patients, SSDI recipients did not have worse clinical outcomes than WC recipients and having undergone =2 previous procedures on the same shoulder was associated with poor outcomes in both groups.
ePosters will be available shortly before Congress
Abstract
Background
Evidence suggests that reverse shoulder arthroplasty (RSA) patients receiving workers’ compensation (WC) have worse patient-reported outcomes (PROs) than those not receiving WC. It is unknown whether Social Security Disability Insurance (SSDI) recipients also have worse outcomes of RSA. Our goals were to 1) compare PROs and range of motion (ROM) after RSA according to whether patients were receiving SSDI, WC, or neither form of assistance, and 2) identify factors associated with poor PROs.
Methods
From a US institutional database of 454 patients who underwent RSA from January 2009 through December 2016, we identified 19 SSDI recipients and 25 WC recipients. From the same database, we created a control group of 81 patients not receiving SSDI or WC, matched by demographic variables. Between groups, we compared age, sex, operative arm dominance, preoperative diagnosis, number of previous shoulder surgeries, primary or revision arthroplasty, and Charlson Comorbidity Index value. Patients were evaluated preoperatively and at a minimum of 2 years postoperatively by physical examination, including range of motion, visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, L'Insalata score, Simple Shoulder Test (SST), and Western Ontario Osteoarthritis of the Shoulder (WOOS) score. Significance was set at p < 0.05. Clinical relevance of improvements in forward flexion and abduction, VAS for pain, ASES, and SST were evaluated using established minimal clinically important difference (MCID) values.
Results
The patients in SSDI group experienced statistically significant (all P < 0.05) improvements from preoperatively to postoperatively for mean PROs of ASES score (23 vs 44), SST (2.5 vs 5), L'Insalata score (39 vs 52), WOOS score (29 vs 43), and VAS for pain (7.9 vs 6) and ROM for abduction (79º vs 93º) and flexion (80º vs 93º). Similaryly patients in WC group experienced statistically significant (all P < 0.05) improvements from preoperatively to postoperatively for mean PROs of ASES score (25 vs 37), SST (2.2 vs 7), L'Insalata score (28 vs 48), WOOS score (30 vs 48), and VAS for pain (7.8 vs 6) and ROM for abduction (71º vs 91º) and flexion (72º vs 94º). These improvements exceeded MCID thresholds in both SSDI and WC groups for ASES, SST score, VAS for pain, forward flexion, and abduction. These outcomes were not significantly different between the SSDI and WC groups. Compared with the control group, both the SSDI and WC groups had statistically significantly worse outcomes for these same measures. Factors associated with poor clinical outcomes were having undergone =2 previous surgical procedures on the same shoulder for which RSA was performed in both SSDI (odds ratio = 2.4, 95% confidence interval: 1.0–5.4) and WC (odds ratio = 1.6, 95% confidence interval: 1.1–4.5) groups.
Conclusion
Among RSA patients, SSDI recipients did not have worse clinical outcomes than WC recipients. Having undergone =2 previous procedures on the same shoulder was associated with poor outcomes in both groups. These findings should be considered when determining the appropriateness of RSA for SSDI and WC recipients.