Impact of pre-operative dementia or cognitive impairment on outcomes after elective primary total shoulder arthroplasty.

Background: Cognitive impairment or dementia has been linked to adverse outcomes in orthopedic surgery. However, studies evaluating its impact on perioperative outcomes after total shoulder arthroplasty (TSA) have been limited. The aim of this study is to examine the association between pre-operative dementia and short-term outcomes following TSA. Methods: Patients undergoing elective primary TSA over 2021-2023 were retrospectively identified and analyzed in the National Surgical Quality Improvement Program database. Patients with and without dementia were matched based on patient demographics and comorbidities. Thirty-day post-operative outcomes such as length of stay and complications were analyzed via univariate analyses. Results: A total of 6,120 patients who underwent elective primary TSA were identified. After 5:1 propensity matching, 219 patients with pre-operative dementia and 1,095 patients without pre-operative dementia were included. The dementia cohort, on average, experienced a longer length of stay (2.2 ± 3.0 days vs. 1.7 ± 4.3 days, Conclusions: Pre-operative dementia is associated with significant increases in adverse short-term outcomes in TSA patients. Dementia may limit patients' ability to follow post-operative instructions, participate in rehabilitation, and manage comorbidities, contributing to worse outcomes. These findings underscore the need for healthcare teams to optimize perioperative and post-operative care in patients with dementia.