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J Shoulder Elbow Surg. 2015 Jan;24(1):24-30. doi: 10.1016/j.jse.2014.05.016. Epub 2014 Aug 29.

Thirty-day morbidity and mortality after elective total shoulder arthroplasty: patient-based and surgical risk factors.

Author information

1
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.
2
Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA.
3
Statistical Consulting Laboratory, University of Texas at El Paso, El Paso, TX, USA.
4
El Paso Orthopaedic Surgery Group, Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, El Paso, TX, USA.
5
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.

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.

KEYWORDS:

Total shoulder arthroplasty; complications; incidence rate; mortality; risk factors

PMID:
25168345
DOI:
10.1016/j.jse.2014.05.016
[Indexed for MEDLINE]

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