Pre-operative Surgical Screening Clinics Provide a Safe Alternative to Primary Care Physician Screening Prior to Total Shoulder Arthroplasty.

Abstract

Preoperative medical evaluation prior to total shoulder arthroplasty (TSA) allows for the mitigation of risk factors to optimize surgical outcomes. Dedicated preoperative surgical clearance clinics, through streamlined protocols and interdisciplinary management, may allow for increased optimization prior to TSA. This study compares 90-day surgical complication and cancellation rates between TSA patients who received a preoperative evaluation from a Primary Care Physician (PCP) and those who received a preoperative evaluation from a Pre-Assessment Surgical Screening (PASS) clinic. A retrospective review of a single-center acute care hospital was conducted for patients who underwent TSA between 2017 through 2024. Variables of interest included patient demographic information, medical comorbidities, surgical cancellation rate, and 90-day complications. Outcomes were compared between patients who underwent PCP versus PASS preoperative clearance utilizing univariate and logistic regression analyses. 1,319 patients met inclusion criteria that comprised 696 (52.8%) and 606 (45.9%) patients evaluated preoperatively by a PCP and PASS clinic, respectively. Comparing PCP and PASS preoperative clinical pathways, there were no differences in patient demographics, medical comorbidities, surgical cancellations, or 90-day complication rates including prosthetic joint infection (PJI). In addition, there were no differences in the previous variables of interest among a subgroup analysis between anatomic (aTSA) and reverse (rTSA) total shoulder arthroplasty patients. We saw no differences in 90-day complications between preoperative evaluation from a PCP and a specialized screening clinic. Preoperative clinics may provide a safe, multidisciplinary, and streamlined approach for preoperative TSA patients, especially those who face challenges when scheduling an appointment with a PCP. However, the decision to receive preoperative evaluation for TSA from a PCP or a preoperative clinic may be influenced more by patient preference and convenience than by differences in clinical outcomes.