SRS284 - Serious adverse events and early readmissions following total shoulder arthroplasty: a systematic review

Abstract Background Total shoulder arthroplasty (TSA) is increasingly performed for degenerative and traumatic shoulder conditions. Although outcomes are generally favourable, serious adverse events (SAEs) and early hospital readmissions remain a clinical concern. This systematic review quantifies SAE incidence, 30- and 90-day readmissions, and identifies key risk factors. Methods Systematic searches of major databases identified 1437 records. After screening and eligibility assessment, 301 studies were included, encompassing >2 million TSA patients. Studies reporting SAEs or early readmissions in relation to demographic, clinical, or procedural variables were eligible. Results Overall SAE incidence ranged 0.1–13.6%, including medical complications (anemia 0.1–13.6%, pneumonia 0.2–2.6%, sepsis 0.4–1.4%, PE 0.2–1.6%, DVT 0.3–1.3%, MI 0.2–0.4%, AKI 0.4–3.9%) and surgical complications (periprosthetic fracture 0.3–0.5%, dislocation 0.1–1.3%, infection 0.3–1.5%, device failure 0.03–0.36%). Thirty-day readmission rates were 1.8–7.8%, and 90-day 2.1–9.7%, with infection, anemia, cardiovascular events, and surgical complications as leading causes. Risk factors consistently identified included age >85, ASA ≥3, dependent functional status, CHF, bleeding disorders, non-home discharge, and disseminated cancer. Perioperative IV dexamethasone reduced sepsis (RR 0.45), AKI (RR 0.64), UTI (RR 0.55), and 90-day readmission (RR 0.61) in large cohort studies. Subgroup analyses highlighted higher SAE rates in reverse TSA compared with anatomic TSA, and in patients with multiple comorbidities. Conclusions SAEs and early readmissions following TSA are uncommon but clinically significant. Optimisation of comorbidities, functional status, discharge planning, and perioperative care can mitigate risk, improving outcomes in this growing patient population.