Anesthetic technique is associated with complication risk and healthcare utilization following total shoulder arthroplasty

Purpose Compare perioperative complications and healthcare utilization among total shoulder arthroplasty (TSA) patients receiving general (GA), regional (RA), or combined anesthesia (RA + GA). Methods Using the TriNetX database, patients undergoing primary TSA were identified and stratified into three groups based on anesthetic technique: GA, RA, and combined RA + GA. 1:1 Propensity score matching was performed to using the GA cohort as reference to control for baseline demographic and clinical covariates. Outcomes of interest included 90-day complication rates including UTI, venous thromboembolism (VTE), acute kidney injury (AKI), prosthetic joint infection (PJI), pneumonia, constipation, and revision TSA, emergency department (ED) visits and hospital readmission, Foley catheter insertion, postoperative opioid prescriptions and mean opioid number of prescriptions. Statistical significance was set at p < 0.05. Results Comparing GA with RA, each cohort consisted of 28,564 patients. RA was associated with lower rates of UTI, AKI, constipation, pneumonia, fewer patients prescribed opioids and fewer opioid prescriptions per patient while being associated with increased healthcare utilization compared to GA alone. Comparing RA + GA with GA alone, 17,926 matched patients were included in each cohort. RA + GA was associated with lower rates of UTI and opioid prescriptions, and higher rates of healthcare utilization compared to GA alone. Conclusion These findings suggest that while RA provides early analgesic and opioid-sparing benefits after TSA, it is associated with increased post-operative healthcare utilization. These findings help guide surgical decision making and highlight the need for standardized perioperative protocols to optimize postoperative pain control and manage rebound pain–related care utilization with RA techniques. Level of Evidence III.