Associations of preoperative patient mental health status, sociodemographic and clinical characteristics with baseline pain, function and satisfaction in patients undergoing primary shoulder arthroplasty.

HYPOTHESIS/BACKGROUND Shoulder pain and dysfunction are common indications for shoulder arthroplasty, yet the factors that are associated with these symptoms are not fully understood. This study aimed to investigate the associations of patient and disease-specific factors with preoperative patient-reported outcome measures (PROMs) in patients undergoing primary shoulder arthroplasty. We hypothesized that worse mental health status assessed by VR-12 MCS, glenoid bone loss, and increasing rotator cuff tear severity would be associated with lower preoperative total PENN Shoulder Score (PSS) and its pain, function, and satisfaction subscores. METHODS Twelve patient factors and four disease-specific factors were prospectively identified as possible statistical predictors for preoperative PROMs in patients undergoing primary shoulder arthroplasty at a single institution over a 3-year period. Multivariable statistical modeling and Akaike's Information Criterion (AIC) comparisons were used to investigate the unique associations with, and relative importance of, these factors in accounting for variation in preoperative PSS and its subscores. RESULTS 788 cases performed by 12 surgeons met inclusion criteria, with a preoperative median total PSS of 31 (pain 10, function 18, satisfaction 1). As hypothesized, lower VR-12 MCS was associated with lower preoperative PSS pain, function and total scores, but patients with intact or small/medium rotator cuff tears had modestly lower PSS pain scores (i.e., more pain) than patients with a large/massive superior-posterior rotator cuff tear. Glenoid bone loss was not associated with preoperative PSS. Female sex, fewer years of education (for all four outcomes), lower VR-12 MCS and preoperative opioid use (for all outcomes but satisfaction), and rotator cuff tear severity (for pain only) were the factors most prominently associated with preoperative PROMs. CONCLUSION In addition to mental health status and rotator cuff tear status, patient sex, years of education, and preoperative opioid use were most prominently associated with preoperative PROMs in patients undergoing shoulder arthroplasty. Further studies are needed to investigate if these factors will also predict postoperative PROMs.