Purpose Disparities in primary total shoulder arthroplasty (TSA) care have been established based on insurance status and patient socioeconomic status; however, there is a paucity of data regarding TSA performed at “safety‐net” hospitals (SNHs). This study sought to describe differences in surgical indications, perioperative complication rates, and follow‐up rates for patients who underwent TSA at a large SNH compared to those who underwent surgery at a private academic hospital (PAH). Materials and methods A retrospective review of adult patients undergoing TSA by a single surgeon at both a large, public SNH and an affiliated PAH between November 2011 and April 2023 was conducted. Patient demographic data, operative indications, and complication data were collected and compared between cohorts. Data were tested for normality via the Shapiro–Wilk test, and then Mann–Whitney U or Student’s t‐testing was conducted as indicated. Significance was defined as p < 0.05. Results A total of 344 patients underwent TSA during the study period, with 92 patients presenting to the SNH and 252 patients presenting to the PAH. Patients presenting to the SNH were younger (63 vs. 70 years) and were more likely to undergo reverse TSA (90.2% vs. 75.8%). The average follow‐up period was significantly shorter at the SNH (319.9 vs. 653.8 days, p = 0.002), with only 29.3% of SNH patients having a clinic visit beyond one year postoperatively versus 45.2% of the PAH patients ( p = 0.008). Infection was the most common complication at the SNH and occurred more frequently than in PAH patients (4.3% vs. 0.4%, p = 0.007). Conclusion TSA may be conducted in SNHs with low rates of early complications. However, surgeons should be aware of high rates of loss to follow‐up and a potentially higher rate of postoperative infection.
Wier et al. (Thu,) studied this question.