Getting the best result from shoulder arthroplasty depends not only on the diagnosis and the excellence of the surgery, but also on the condition of the patient. As presented in Patient's Guide to Optimal Recovery there is much we can do to help the patient in optimizing their outcome.
What other non-surgical factors should we consider prior to performing elective shoulder arthroplasty? One area of focus is preemptively identifying and managing comorbidities, such as anemia, cardioopulmonary conditions, kidney disease and depression.
Another set of high impact factors are the often-overlooked socioeconomic determinants of health
What Are Social Determinants of Health and Why Should They Matter to an Orthopaedic Surgeon? points out that SDOH are nonmedical factors that impact health outcomes and are defined as “the conditions in which people are born, live, work, learn, worship, play, and age.” The SDOH are separated into 5 domains: economic stability (job opportunities and income), education (literacy skills), health and health care, neighborhood and the built environment (safe housing, opportunities for physical activity, access to nutritious food, and water pollution), and social and community context (race, ethnicity, gender, and LGBTQ+ [lesbian, gay, bisexual, transgender, queer, and more] identity). People with adverse social determinants of health are less likely to undergo surgical procedures, and when they are treated surgically, they are more likely to have poor postoperative outcomes compared with people without adverse SDOH.
The Centers for Medicare & Medicaid Services (CMS) has created an Accountable Health Communities Health-Related Social Needs Screening Tool. Other such tools are listed in the article. The bottom line is that SDOH are important predictors of poorer outcomes in orthopaedic patients. Patients with SDOH should be connected preoperatively with the necessary resources to improve their outcome.
A recent article points to the importance of SDOH in shoulder surgery,
The Impact of Socioeconomic Factors on 90-day Postoperative Readmissions and Cost in Shoulder Arthroplasty Patients found that patients in the high area deprivation index (ADI) group had a higher readmission rate than the lowest ADI group and noted a dose-dependent relationship between ADI and readmission, with the association growing stronger as ADI increased and a negative association with ADI and high-costs. The Neighborhood Atlas provides a free interactive map where you can enter an address, ZIP code, or county to find the ADI ranking. Here is the ADI map for the state of Washington. Note wide variation between the deprived areas (red) and the non-deprived areas (blue).
Unfortunatly, articles such as Medicaid Status is Independently Predictive of Increased Complications, Readmission, and Mortality Following Primary Total Shoulder Arthroplasty confuse cause and effect by stating that "Medicaid status was independently predictive of readmission, complications, and mortality within 180 days of primary TSA, as well as other specific medical and surgical complications. Medicaid patients experience higher admission costs and longer hospital stays compared to those with other insurance types". This an example of a Fundamental Attribution Error. Instead of the stated conclusions of the article, it is apparent that poorer social determinants of health are independently predictive of Medicaid status as well as readmission, complications and mortality after shoulder arthroplasty. Changing the patient's insurance will not change their risk of adverse outcomes, whereas addressing the challenges imposed by poor social determinants of health may help improve the results of surgery.
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link)
Shoulder rehabilitation exercises (see this link).
