Severe obesity as an independent risk factor for post-operative dislocation following reverse total shoulder arthroplasty: a PearlDiver database analysis.
- 1Department of Orthopaedic Surgery, Yale University, New Haven, CT, USA.
Abstract
Reverse total shoulder arthroplasty (rTSA) is a reliable procedure for a broad spectrum of shoulder pathologies, with post-operative dislocation representing a clinically impactful complication. Obesity has been associated with adverse peri-operative outcomes following shoulder arthroplasty; however, it has not been specifically assessed in relation to post-operative dislocation in the setting of rTSA. We hypothesized that severe obesity (body mass index [BMI] >35 kg/m2, corresponding to World Health Organization class II obesity) would be independently associated with an increased risk of dislocation following rTSA. A retrospective cohort study was performed using the PearlDiver Mariner national administrative claims database. Patients aged >17 years who underwent primary rTSA for degenerative shoulder osteoarthritis were identified using International Classification of Diseases, Tenth Revision (ICD-10) procedural codes. Patients with shoulder trauma, neoplasm, or infection within 90 days of the index procedure were excluded. Two cohorts were defined: non-obese (BMI <30 kg/m2) and severely obese (BMI >35 kg/m2; patients with BMI 30-35 kg/m2 were excluded), and matched 4:1 by age, sex, Elixhauser Comorbidity Index, and smoking status. Post-operative dislocation was identified using ICD-10 diagnostic codes (ICD-10-D-T84028A, ICD-10-D-T84029A). Outcomes were assessed at 6 months, 1 year, and 2 years post-operatively. Multivariable logistic regression and Kaplan-Meier survival analyses were performed. After 4:1 matching, 12,667 non-obese and 3,210 severely obese patients were included. Severely obese patients demonstrated statistically significantly higher rates of post-operative dislocation at 6 months (2.43% vs. 1.46%; P = .0002), 1 year (2.83% vs. 1.75%; P = .0001), and 2 years (3.30% vs. 2.16%; P = .0002). This corresponds to an absolute risk increase of approximately 1.1% at 2 years. On multivariable logistic regression, severe obesity was independently associated with increased dislocation risk at 2 years (odds ratio 1.54, 95% confidence interval 1.23-1.96; P < .0001), corresponding to a 54% relative increase in odds. Kaplan-Meier analysis demonstrated statistically significantly lower dislocation-free survivorship in the severely obese cohort (log-rank P < .0001). All 3 time-point comparisons remained statistically significant after Bonferroni correction (adjusted α = 0.017). Severe obesity (BMI >35 kg/m2) was associated with a statistically significant but modest increase in the risk of post-operative dislocation following rTSA at short-term follow-up. The magnitude of the association was moderate and the absolute risk difference small. These findings support obesity-specific pre-operative risk counseling on the risk of post-operative instability after rTSA.
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BibTeX
@article{donnelley2026severe,
title = {{Severe obesity as an independent risk factor for post-operative dislocation following reverse total shoulder arthroplasty: a PearlDiver database analysis.}},
author = {Claire A Donnelley and Jonathan White and Joshua G Sanchez and Victoria Kong and Jonathan N Grauer and Xuan Luo},
journal = {Journal of shoulder and elbow arthroplasty},
year = {2026},
month = sep,
doi = {10.1016/j.jsea.2026.100109},
url = {https://europepmc.org/article/MED/42999519},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Severe obesity as an independent risk factor for post-operative dislocation following reverse total shoulder arthroplasty: a PearlDiver database analysis.
AU - Claire A Donnelley
AU - Jonathan White
AU - Joshua G Sanchez
AU - Victoria Kong
AU - Jonathan N Grauer
AU - Xuan Luo
PY - 2026
DA - 2026/09/30
JO - Journal of shoulder and elbow arthroplasty
DO - 10.1016/j.jsea.2026.100109
UR - https://europepmc.org/article/MED/42999519
AB - Reverse total shoulder arthroplasty (rTSA) is a reliable procedure for a broad spectrum of shoulder pathologies, with post-operative dislocation representing a clinically impactful complication. Obesity has been associated with adverse peri-operative outcomes following shoulder arthroplasty; however, it has not been specifically assessed in relation to post-operative dislocation in the setting of rTSA. We hypothesized that severe obesity (body mass index [BMI] >35 kg/m2, corresponding to World Health Organization class II obesity) would be independently associated with an increased risk of dislocation following rTSA. A retrospective cohort study was performed using the PearlDiver Mariner national administrative claims database. Patients aged >17 years who underwent primary rTSA for degenerative shoulder osteoarthritis were identified using International Classification of Diseases, Tenth Revision (ICD-10) procedural codes. Patients with shoulder trauma, neoplasm, or infection within 90 days of the index procedure were excluded. Two cohorts were defined: non-obese (BMI <30 kg/m2) and severely obese (BMI >35 kg/m2; patients with BMI 30-35 kg/m2 were excluded), and matched 4:1 by age, sex, Elixhauser Comorbidity Index, and smoking status. Post-operative dislocation was identified using ICD-10 diagnostic codes (ICD-10-D-T84028A, ICD-10-D-T84029A). Outcomes were assessed at 6 months, 1 year, and 2 years post-operatively. Multivariable logistic regression and Kaplan-Meier survival analyses were performed. After 4:1 matching, 12,667 non-obese and 3,210 severely obese patients were included. Severely obese patients demonstrated statistically significantly higher rates of post-operative dislocation at 6 months (2.43% vs. 1.46%; P = .0002), 1 year (2.83% vs. 1.75%; P = .0001), and 2 years (3.30% vs. 2.16%; P = .0002). This corresponds to an absolute risk increase of approximately 1.1% at 2 years. On multivariable logistic regression, severe obesity was independently associated with increased dislocation risk at 2 years (odds ratio 1.54, 95% confidence interval 1.23-1.96; P < .0001), corresponding to a 54% relative increase in odds. Kaplan-Meier analysis demonstrated statistically significantly lower dislocation-free survivorship in the severely obese cohort (log-rank P < .0001). All 3 time-point comparisons remained statistically significant after Bonferroni correction (adjusted α = 0.017). Severe obesity (BMI >35 kg/m2) was associated with a statistically significant but modest increase in the risk of post-operative dislocation following rTSA at short-term follow-up. The magnitude of the association was moderate and the absolute risk difference small. These findings support obesity-specific pre-operative risk counseling on the risk of post-operative instability after rTSA.
SN - 2471-5492
ER -