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Thirty-day morbidity and mortality after elective total shoulder arthroplasty: patient-based and surgical risk factors.
J Shoulder Elbow Surg. 2015 Jan; 24(1):24-30.JS

Abstract

BACKGROUND

Total shoulder arthroplasty (TSA) is an effective treatment for painful glenohumeral arthritis, but its morbidity has not been thoroughly documented.

METHODS

The National Surgical Quality Improvement Program database was queried to identify all patients undergoing primary TSA between 2006 and 2011, with extraction of selected patient-based or surgical variables and 30-day clinical course. Postoperative complications were stratified as major systemic, minor systemic, major local, and minor local, and mortality was recorded. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were derived from bivariate and multivariable analysis to express the association between risk factors and clinical outcomes.

RESULTS

Among the 2004 patients identified, the average age was 69 years, and 57% were women. Obesity was present in 46%, and 48% had an American Society of Anesthesiologists classification of ≥3. The 30-day mortality and total complication rates were 0.25% and 3.64%, respectively. Comorbid cardiac disease (OR, 85.31; 95% CI, 8.15, 892.84) and increasing chronologic age (OR, 1.19; 95% CI, 1.06, 1.33) were independent predictors of mortality, whereas peripheral vascular disease was associated with statistically significant increase in any complication (OR, 6.25; 95% CI, 1.24, 31.40). Operative time >174 minutes was an independent predictor for development of a major local complication (OR, 4.05; 95% CI, 1.45, 11.30). Obesity was not associated with any specified complication after controlling for other variables.

CONCLUSIONS

Whereas TSA has low short-term rates of perioperative complications and mortality, careful perioperative medical optimization and efficient surgical technique should be emphasized to decrease morbidity and mortality.

Authors+Show Affiliations

Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA. Electronic address: brian.r.waterman@us.army.mil.Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA.Statistical Consulting Laboratory, University of Texas at El Paso, El Paso, TX, USA.El Paso Orthopaedic Surgery Group, Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, El Paso, TX, USA.Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25168345

Citation

Waterman, Brian R., et al. "Thirty-day Morbidity and Mortality After Elective Total Shoulder Arthroplasty: Patient-based and Surgical Risk Factors." Journal of Shoulder and Elbow Surgery, vol. 24, no. 1, 2015, pp. 24-30.
Waterman BR, Dunn JC, Bader J, et al. Thirty-day morbidity and mortality after elective total shoulder arthroplasty: patient-based and surgical risk factors. J Shoulder Elbow Surg. 2015;24(1):24-30.
Waterman, B. R., Dunn, J. C., Bader, J., Urrea, L., Schoenfeld, A. J., & Belmont, P. J. (2015). Thirty-day morbidity and mortality after elective total shoulder arthroplasty: patient-based and surgical risk factors. Journal of Shoulder and Elbow Surgery, 24(1), 24-30. https://doi.org/10.1016/j.jse.2014.05.016
Waterman BR, et al. Thirty-day Morbidity and Mortality After Elective Total Shoulder Arthroplasty: Patient-based and Surgical Risk Factors. J Shoulder Elbow Surg. 2015;24(1):24-30. PubMed PMID: 25168345.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thirty-day morbidity and mortality after elective total shoulder arthroplasty: patient-based and surgical risk factors. AU - Waterman,Brian R, AU - Dunn,John C, AU - Bader,Julia, AU - Urrea,Luis, AU - Schoenfeld,Andrew J, AU - Belmont,Philip J,Jr Y1 - 2014/08/29/ PY - 2014/01/16/received PY - 2014/05/06/revised PY - 2014/05/15/accepted PY - 2014/8/30/entrez PY - 2014/8/30/pubmed PY - 2015/4/18/medline KW - Total shoulder arthroplasty KW - complications KW - incidence rate KW - mortality KW - risk factors SP - 24 EP - 30 JF - Journal of shoulder and elbow surgery JO - J Shoulder Elbow Surg VL - 24 IS - 1 N2 - BACKGROUND: Total shoulder arthroplasty (TSA) is an effective treatment for painful glenohumeral arthritis, but its morbidity has not been thoroughly documented. METHODS: The National Surgical Quality Improvement Program database was queried to identify all patients undergoing primary TSA between 2006 and 2011, with extraction of selected patient-based or surgical variables and 30-day clinical course. Postoperative complications were stratified as major systemic, minor systemic, major local, and minor local, and mortality was recorded. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were derived from bivariate and multivariable analysis to express the association between risk factors and clinical outcomes. RESULTS: Among the 2004 patients identified, the average age was 69 years, and 57% were women. Obesity was present in 46%, and 48% had an American Society of Anesthesiologists classification of ≥3. The 30-day mortality and total complication rates were 0.25% and 3.64%, respectively. Comorbid cardiac disease (OR, 85.31; 95% CI, 8.15, 892.84) and increasing chronologic age (OR, 1.19; 95% CI, 1.06, 1.33) were independent predictors of mortality, whereas peripheral vascular disease was associated with statistically significant increase in any complication (OR, 6.25; 95% CI, 1.24, 31.40). Operative time >174 minutes was an independent predictor for development of a major local complication (OR, 4.05; 95% CI, 1.45, 11.30). Obesity was not associated with any specified complication after controlling for other variables. CONCLUSIONS: Whereas TSA has low short-term rates of perioperative complications and mortality, careful perioperative medical optimization and efficient surgical technique should be emphasized to decrease morbidity and mortality. SN - 1532-6500 UR - https://www.unboundmedicine.com/medline/citation/25168345/Thirty_day_morbidity_and_mortality_after_elective_total_shoulder_arthroplasty:_patient_based_and_surgical_risk_factors_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1058-2746(14)00277-8 DB - PRIME DP - Unbound Medicine ER -