Citation

Kaiser TJ, Shanley E, Denninger T, Reuschel B, Kissenberth MJ, Tolan SJ, Thigpen CA, Pill SG. J. Shoulder Elbow Surg. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, American Shoulder and Elbow Surgeons, Publisher Elsevier Publishing)

DOI

10.1016/j.jse.2021.04.004

PMID

unavailable

Abstract

INTRODUCTION: Fall risk is an acknowledged but relatively understudied concern for older patients undergoing shoulder surgery. The cause is multifactorial, but includes: advanced age, impaired upper extremity function, the use of shoulder abduction braces, and postoperative use of opioid medications. No previous study has examined preoperative fall risk in patients undergoing elective shoulder surgery. Previous literature looking at fall risk in elective orthopedic procedures has predominantly focused on falls occurring in the hospital setting, although falls have also been shown to occur in the outpatient setting. Gait speed and Timed Up and Go (TUG) are well-researched functional measures in the aging population with established cut-off scores indicating increased fall risk. The purpose of this study was to quantify gait speed and TUG scores in a series of patients who were scheduled to undergo either rotator cuff repair (RCR) or total shoulder arthroplasty (TSA) in order to assess overall risk of fall in these populations.

METHODS: 198 patients scheduled for TSA or RCR surgery were evaluated preoperatively from multiple outpatient physical therapy clinics within Greenville, South Carolina. The TUG score (>14 seconds considered high fall risk) and 10 Meter Walk test (<0.7 m/s considered high risk for falls) were recorded for each patient. Patient reported outcomes were also collected, including: Veteran's Rand 12 (VR-12) Physical Component Score (PCS) & Mental Component Score (MCS), American Shoulder and Elbow Surgeons score (ASES), and the Single Alpha-Numeric Evaluation (SANE).

RESULTS: Patients undergoing TSA (n = 80; 65.4 ± 11.4 years) were older than those undergoing RCR (n = 118; 59.0 ± 14.2 years). Fifty-nine percent of all patients were classified as being a high risk for falls based on gait speed <0.7 m/s. Patients in the TSA group were more likely to display preoperative fall risk compared to patients in the RCR group (62% vs. 38%; x;=8.9 P=0.03). There were no significant differences in ambulatory status, VR-12 PCS or MCS, ASES, or SANE between groups (P=0.11).

DISCUSSION: Both patient groups demonstrated a high rate of fall risk in preoperative evaluation. Patients undergoing TSA more often displayed fall risk compared to patients undergoing RCR. While patients in the TSA group were older, there was no association between age or ambulatory status and fall risk.

CONCLUSION: Our results suggest that fall risk screening may be important for patients undergoing TSA and RCR surgeries. The higher fall risk in the TSA group may be an important consideration as this procedure shifts towards outpatient status.

Language: en

Keywords

fall risk; Arthroplasty; preop; Rotator cuff repair; timed up and go