How safe is it to do a reverse total shoulder for 80 year old patients?

Reverse Total Shoulder Arthroplasty in Patients Eighty Years of Age and Older : A National Database Analysis of Complications and Mortality

These authors queried PearlDiver Database (which contains services rendered to Medicare, Medicaid, and commercial insurance patients) for patients undergoing reverse total shoulder (RSA), comparing those 80 years of age and older to patients under 80 years of age with respect to the incidence of

1revision arthroplasty, medical complications, and surgical complications. 

29,430 cases of RSA were included with 486 cases in patients 80 years and older. While patients over and under 80 had seemingly comparable comorbidities preoperatively:

patients 80 years and older had higher rates of deep venous thrombosis (DVT) (OR 2.87), urinary tract infection (OR 1.42), acute renal failure (OR 2.18) and pneumonia (OR 1.75) within 90 days postoperatively as well as a significantly higher 90-day mortality rate at 2.7% compared to 1.5% in younger patients.

On the other hand, patients 80 years and older had 3.9, and 5.1% 1, and 2-year revision rates, compared to the younger cohort at 3.0, and 3.1%, respectively. Patients >80 experienced lower rates of dislocation, stiffness, periprosthetic fracture, and implant complications 1-year postoperatively. 

As the authors note, the median age of patients "80 and older" was 80, so these data may not extrapolate to those much older than 80.

The bottom line seems to be that while the preoperative health of 80 year old patients may seem to be as healthy as those younger, the stress of rTSA seems to challenge the medical resiliency of some of them, leading to an increased rate of serious medical complications and death.

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