Serious Adverse Events and 30- and 90-Day Readmission Rates Following Anatomical Versus Reverse Total Shoulder Arthroplasty: A Systematic Review and Meta-Analysis

Introduction Reverse total shoulder arthroplasty (rTSA) has expanded rapidly, but its early postoperative outcomes relative to anatomic TSA (aTSA) remain unclear. This systematic review and meta-analysis evaluate serious adverse events (SAEs) and 30- and 90-day readmission rates following primary aTSA and rTSA. Method A systematic search of PubMed, Embase, Medline, Scopus, and Web of Science were performed through July 2025. Studies reporting SAEs or early readmissions after primary TSA were included. Risk of bias was assessed using ROBINS-I and RoB 2. Random-effects meta-analyses were conducted to estimate pooled event rates and comparative odds ratios (ORs) between rTSA and aTSA, and single-arm meta-analyses to determine pooled event rates for each procedure. Results Forty-six studies encompassing 1,445,486 patients (rTSA: 885,825; aTSA: 559,661) were included. Comparative analyses demonstrated that rTSA was associated with higher odds of SAEs (OR 1.38; 95% CI 1.10-1.74), 30-day readmission (OR 1.71; 95% CI 1.47-1.98), and 90-day readmission (OR 1.53; 95% CI 1.34-1.75) compared with aTSA. Single-arm pooled rates confirmed higher absolute event rates for rTSA (SAE 8.78% vs 5.28%; 30-day readmission 3.16% vs 1.24%; 90-day readmission 4.09% vs 3.05%). Both procedures exhibited low overall mortality, but rTSA had increased dislocation, infection, and revision rates, whereas aTSA showed higher mechanical loosening and rotator cuff failure. Conclusion rTSA carries higher perioperative morbidity and early readmission compared with aTSA, although absolute rates remain low. These findings underscore the importance of procedure-specific patient selection, comorbidity optimization, and tailored perioperative care to mitigate early complications and enhance value-based shoulder arthroplasty outcomes.