Are perioperative complications and clinical outcomes following reverse shoulder arthroplasty adversely affected by obesity? A systematic review

Purpose: Obesity has been studied in relation to perioperative medical and surgical complications, as well as clinical outcomes following reverse total shoulder arthroplasty (rTSA), with often inconsistent conclusions reached. The purpose of this systematic review is to synthesize the reported correlations between elevated body mass index (BMI) and both the complications and clinical outcomes following rTSA. Methods: An extensive literature search of the PubMed, Embase, ScienceDirect, and Google Scholar databases was conducted through March 2020. Clinical studies that specifically examined the relationship between BMI and perioperative complications and functional outcomes following rTSA were included. Public databases (NIS, ACS-NSQIP, PearlDiver, and statewide databases) were largely excluded from the analysis unless procedural codes allowed for differentiation between rTSA, anatomic total shoulder arthroplasty (aTSA), and humeral head replacement. Results: Nineteen studies were included in this systematic review—11 reported solely on perioperative complications, 2 solely on functional outcomes, and 6 on both complications and outcomes following rTSA. There was no association found between obesity and an increased risk for periprosthetic fracture, scapular stress fracture, periprosthetic infection, instability, overall complications, perioperative medical and surgical complications, mortality, extended length of stay (LOS), increased need for transfusion and likelihood of 90-day readmission. Obesity was associated with prolonged operative time, increased absolute hospital LOS, increased blood loss, higher hospital costs, lower risk for scapular notching, higher likelihood of discharge to a rehabilitation facility, and higher risk for revision surgery. Range of motion of the operative shoulder, pain, and patient-reported outcome measures have generally demonstrated significant improvement following rTSA. Conclusion: Despite some conflicting results in the existing literature regarding the effect of BMI and complications following rTSA, obesity is not universally associated with increased perioperative complications. Range of motion and patient-reported functional outcomes can be expected to improve, even among patients with morbid obesity. Level of evidence: Level IV; Review