Outcomes Following Total Shoulder Arthroplasty in Geriatric Patients with Anorexia of Aging

Alexander R. Zhu; Eric Mao; Emma Giarracco; Henry Stewart; Seyedeh Z. Mousavi; Ashley R. Zhu; Umasuthan Srikumaran

Abstract

Background: Anorexia of aging (AoA), characterized by decreased appetite/food intake in elderly individuals, leads to malnutrition, sarcopenia, and frailty. While these factors are associated with increased postoperative complications in orthopaedic patients, the relationship between AoA and total shoulder arthroplasty (TSA) outcomes is unknown.Purpose: To evaluate the association between AoA and postoperative outcomes following TSA in geriatric patients.Methods: Using TriNetX platform data, this retrospective study compared outcomes between AoA patients ≥ 65 years undergoing TSA and non-AoA patients ≥ 65 years undergoing TSA. Propensity score matching controlled for demographic and comorbidity differences. Outcomes were assessed at 90 days, 1 year, and 2 years postoperatively and included acute kidney failure, myocardial infarction, deep vein thrombosis, pulmonary embolism, pneumonia, mechanical ventilation, dehiscence, sepsis, infection (superficial, deep, prosthetic), revision TSA, aseptic loosening, prosthesis dislocation, periprosthetic fracture, and mortality.Results: From 64,788 patients, 1,044 matched pairs were analyzed. AoA patients showed higher revision TSA rates at 90 days (3.4% vs 1.6%, P = 0.0115), but not at 1 year (3.8% vs 2.6%, P = 0.1065) or 2 years (4.4% vs 3.1%, P = 0.1062). AoA was significantly associated with increased mortality at 90 days (1.0% vs 0%, P = 0.0015), but this association disappeared at 1 year (3.3% vs 2.6%, P = 0.3630) and 2 years (5.4% vs 4.6%, P = 0.4210). AoA was also associated with a higher incidence of deep vein thrombosis (DVT) and pneumonia at 90 days, 1 year, and 2 years (all P-values < 0.05).Conclusions: AoA was associated with increased short-term revision surgery and mortality following TSA, as well as higher overall risk of DVT and pneumonia. These findings underscore the need for tailored preoperative and postoperative care strategies to improve outcomes in geriatric patients with AoA undergoing TSA.What this study adds: This study is the first to demonstrate an association between anorexia of aging and increased short-term risks of revision surgery, mortality, deep vein thrombosis, and pneumonia following total shoulder arthroplasty in older adults.Potential impacts on research, practice or policy: These findings emphasize the importance of preoperative screening for anorexia of aging.Study Design: Retrospective Study-DefinedLevel of Evidence: IIIKeywords: Anorexia of aging; Malnutrition; Total shoulder arthroplasty; Geriatric surgery; Revision surgery; Postoperative complicationshttps://doi.org/10.70885/hmsj.2025.12.001

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