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Analysis of perioperative complications in patients after total shoulder arthroplasty and reverse total shoulder arthroplasty.
J Shoulder Elbow Surg. 2014 Dec; 23(12):1852-1859.JS

Abstract

BACKGROUND

Data directly comparing the perioperative complication rates between total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) are limited.

METHODS

The Nationwide Inpatient Sample database, which comprises data from a statistically representative sample of hospitals across the United States, was analyzed for the years 2010 and 2011. The International Classification of Diseases, Ninth Revision procedure codes differentiated the patients who received TSA (81.80) and RTSA (81.88). Demographic data, comorbidities, perioperative complications, and hospitalization data were compared.

RESULTS

This retrospective analysis included 19,497 patients, with 14,031 patients in the TSA group and 5466 patients in the RTSA group. Patients who underwent RTSA were older (P < .001), were more likely to be female (P < .001), and had increased rates of fracture (P < .001). The RTSA group had significantly higher perioperative rates of mortality (P = .004), pneumonia (P < .001), deep venous thrombosis (P < .001), myocardial infarction (P = .005), urinary tract infection (P < .001), and blood transfusions (P < .001). In addition, the RTSA patients had longer hospital stays (P < .001) and higher hospital charges (P < .001). The rates of comorbidities were also higher in the patients who underwent RTSA. After adjustment for these differences in comorbidities and surgical indications with our multivariate analysis, RTSA was still independently associated with increased hospital charges (difference of $11,530; P < .001), longer hospitalization (difference of 0.24 day; P < .001), more blood transfusions (relative risk, 1.43; P < .001) and higher rates of pneumonia (relative risk, 1.61; P = .04) and deep venous thrombosis (relative risk, 2.24; P = .01).

CONCLUSION

We found that RTSA patients, compared with TSA patients, had significantly longer length of stay, higher hospital charges that are not completely attributable to increased implant costs alone, and increased rates of perioperative complications.

Authors+Show Affiliations

Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL, USA.Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL, USA.Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL, USA.Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL, USA; Department of Orthopaedic Surgery, NorthShore University HealthSystem, Evanston, IL, USA. Electronic address: kohj1@hotmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25156959

Citation

Jiang, Jimmy J., et al. "Analysis of Perioperative Complications in Patients After Total Shoulder Arthroplasty and Reverse Total Shoulder Arthroplasty." Journal of Shoulder and Elbow Surgery, vol. 23, no. 12, 2014, pp. 1852-1859.
Jiang JJ, Toor AS, Shi LL, et al. Analysis of perioperative complications in patients after total shoulder arthroplasty and reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2014;23(12):1852-1859.
Jiang, J. J., Toor, A. S., Shi, L. L., & Koh, J. L. (2014). Analysis of perioperative complications in patients after total shoulder arthroplasty and reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery, 23(12), 1852-1859. https://doi.org/10.1016/j.jse.2014.04.008
Jiang JJ, et al. Analysis of Perioperative Complications in Patients After Total Shoulder Arthroplasty and Reverse Total Shoulder Arthroplasty. J Shoulder Elbow Surg. 2014;23(12):1852-1859. PubMed PMID: 25156959.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Analysis of perioperative complications in patients after total shoulder arthroplasty and reverse total shoulder arthroplasty. AU - Jiang,Jimmy J, AU - Toor,Aneet S, AU - Shi,Lewis L, AU - Koh,Jason L, Y1 - 2014/08/23/ PY - 2013/10/08/received PY - 2014/04/15/revised PY - 2014/04/16/accepted PY - 2014/8/27/entrez PY - 2014/8/27/pubmed PY - 2015/4/8/medline KW - Reverse total shoulder arthroplasty KW - complication KW - perioperative outcome KW - total shoulder arthroplasty SP - 1852 EP - 1859 JF - Journal of shoulder and elbow surgery JO - J Shoulder Elbow Surg VL - 23 IS - 12 N2 - BACKGROUND: Data directly comparing the perioperative complication rates between total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) are limited. METHODS: The Nationwide Inpatient Sample database, which comprises data from a statistically representative sample of hospitals across the United States, was analyzed for the years 2010 and 2011. The International Classification of Diseases, Ninth Revision procedure codes differentiated the patients who received TSA (81.80) and RTSA (81.88). Demographic data, comorbidities, perioperative complications, and hospitalization data were compared. RESULTS: This retrospective analysis included 19,497 patients, with 14,031 patients in the TSA group and 5466 patients in the RTSA group. Patients who underwent RTSA were older (P < .001), were more likely to be female (P < .001), and had increased rates of fracture (P < .001). The RTSA group had significantly higher perioperative rates of mortality (P = .004), pneumonia (P < .001), deep venous thrombosis (P < .001), myocardial infarction (P = .005), urinary tract infection (P < .001), and blood transfusions (P < .001). In addition, the RTSA patients had longer hospital stays (P < .001) and higher hospital charges (P < .001). The rates of comorbidities were also higher in the patients who underwent RTSA. After adjustment for these differences in comorbidities and surgical indications with our multivariate analysis, RTSA was still independently associated with increased hospital charges (difference of $11,530; P < .001), longer hospitalization (difference of 0.24 day; P < .001), more blood transfusions (relative risk, 1.43; P < .001) and higher rates of pneumonia (relative risk, 1.61; P = .04) and deep venous thrombosis (relative risk, 2.24; P = .01). CONCLUSION: We found that RTSA patients, compared with TSA patients, had significantly longer length of stay, higher hospital charges that are not completely attributable to increased implant costs alone, and increased rates of perioperative complications. SN - 1532-6500 UR - https://www.unboundmedicine.com/medline/citation/25156959/Analysis_of_perioperative_complications_in_patients_after_total_shoulder_arthroplasty_and_reverse_total_shoulder_arthroplasty_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1058-2746(14)00229-8 DB - PRIME DP - Unbound Medicine ER -