AB255. SOH26AB_0158. Preoperative health status as a predictor of hospital stay, discharge destination, and complications following reverse shoulder arthroplasty: a systematic review

Background: Reverse shoulder arthroplasty (RSA) is increasingly performed in medically complex patients. Preoperative health status may influence short-term outcomes, yet the predictive value of comorbidity and frailty measures in RSA remains unclear. This systematic review evaluated whether preoperative health indices predict postoperative complications, readmissions, length of stay (LOS), and discharge destination following RSA.

Methods: A systematic search of PubMed, Embase, Scopus, and Cochrane Library was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies included patients undergoing primary RSA reporting an association between preoperative health status, measured using the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index (ECI), American Society of Anaesthesiologists (ASA) grade, or modified Frailty Index (mFI), and postoperative outcome (complications, readmissions, LOS, or discharge destination)

Results: Thirteen studies comprising 375,819 RSA patients met the inclusion criteria. Preoperative health status was measured using CCI (n=5 studies), ASA grade (n=5), ECI (n=4), and mFI (n=1). Postoperative complications were reported in 10 studies, 90-day readmissions in four studies, discharge destination in three studies, and LOS in two studies. Across indices, a greater preoperative score predicted higher postoperative complication rates and increased likelihood of readmission. Studies reporting LOS and discharge destination demonstrated similar patterns, with poorer preoperative health status associated with prolonged hospitalization and non-home discharge.

Conclusions: Preoperative comorbidity and frailty measures, particularly CCI, ECI, and ASA grade, appear to be meaningful predictors of short-term postoperative outcomes following RSA. Standardized RSA-specific prognostic research is needed to refine risk stratification and support preoperative optimization.

Keywords: Reverse shoulder arthroplasty (RSA); Charlson Comorbidity Index (CCI); Elixhauser Comorbidity Index (ECI); American Society of Anaesthesiologists grade (ASA grade); modified Frailty Index (mFI)