Preoperative patient-reported scores can predict postoperative outcomes after shoulder arthroplasty

Abstract

Background: Total shoulder arthroplasty and reverse total shoulder arthroplasty are increasingly used to improve pain and function in patients with glenohumeral arthritis or cuff tear arthropathy. Our objective was to determine if preoperative patient-reported outcome measures predict which patients will achieve clinically meaningful improvements after shoulder arthroplasty.

Methods: Preoperative and 1-year postoperative 12-Item Short Form Health Survey (SF-12) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores and American Shoulder and Elbow Surgeons (ASES) pain and function scores were prospectively collected from 107 patients who underwent total or reverse shoulder arthroplasty. The minimum clinically important difference (MCID) defined meaningful clinical improvement. Receiver operating characteristic analysis was used to calculate threshold values and C statistic. Multivariate logistic regression analysis was performed to determine preoperative measures that were indicative of achieving the MCID postoperatively.

Results: Threshold values below which patients were more likely to achieve MCID were 12 for ASES function, 25 for ASES pain, 46 for SF-12 PCS, and 42 for SF-12 MCS. Multivariate analysis revealed that preoperative ASES function (area under the curve, 0.79; P = .006) and ASES pain (area under the curve, 0.90; P < .001) measures were predictive of achieving the MCID postoperatively. Patients with higher preoperative SF-12 MCS scores had a higher likelihood of achieving MCID for each measure.

Conclusion: We determined threshold values that predict clinically meaningful improvement after shoulder arthroplasty. Patients with higher preoperative mental health scores and lower physical function and pain scores were more likely to gain significant benefits from surgery. These results can be used to facilitate shared decision-making and to forecast expected benefits after shoulder arthroplasty.

Keywords: ASES score; SF-12 score; Total shoulder arthroplasty; patient-reported outcomes; reverse total shoulder arthroplasty; shoulder arthroplasty outcomes.