Authors’ Disclosure Statement: Dr. Jobin reports that he has received consultant payments from Acumed, Depuy Synthes, Wright-Tornier, and Zimmer Biomet, which is not directly related to the subject of this work; receives grant support from American Shoulder & Elbow Surgeons and grant funding from Orthopedic Scientific Research Foundation not related to the subject of this work; and he is on the editorial board of the Journal of American Academy of Orthopedic Surgeons (JAAOS). Dr. Levine reports that he is an unpaid consultant for Zimmer Biomet, receives research grant financial support from Smith and Nephew not directly related to the subject of this work, and is on the editorial/governing board of the Journal of American Academy of Orthopedic Surgeons (JAAOS). Dr. Ahmad reports that he receives intellectual property royalties, is a paid consultant to, and receives research support from Arthrex; receives stock or stock options from At Peak; receives publishing royalties and financial or material support from Lead Player; receives research support from Major League Baseball; receives research support from Stryker; and is on the editorial or governing board for Orthopedics Today. The other authors report no actual or potential conflict of interest in relation to this article.
Dr. Anakwenze is an Orthopedic Surgeon, Olympus Orthopedic Medical Group, San Diego, California. Dr. O’Donnell is a Resident, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York. Dr. Jobin, Dr. Levine, and Dr. Ahmad are Orthopedic Surgeons, Department of Orthopedic Surgery, Columbia University, New York, New York.
Address correspondence to: Oke A Anakwenze, MD, Olympus Orthopedic Medical Group, 3750 Convoy Street, Suite 201, San Diego, CA 92111 (email, oaa@olympusortho.com).
Oke A. Anakwenze, MD Evan A. O’Donnell, BA Charles M. Jobin, MDWilliam N. Levine, MD Christopher S. Ahmad, MD . Medical Complications and Outcomes After Total Shoulder Arthroplasty: A Nationwide Analysis. Am J Orthop.
October 4, 2018
TAKE HOME POINTS
Medical complications are common (6.7%) after total shoulder arthroplasty.
Age and preoperative medical comorbidities increased the risk of a postoperative complication.
The most frequent medical complications are respiratory, renal, and cardiac.
Length of stay was effected most by shock, infections, and vascular complications.
Mortality was associated with major complications such as, shock, central nervous system, cardiac, vascular, and respiratory complications.
References
ABSTRACT
There is a paucity of evidence describing the types and rates of postoperative complications following total shoulder arthroplasty (TSA). We sought to analyze the complications following TSA and determine their effects on described outcome measures.
Using discharge data from the weighted Nationwide Inpatient Sample from 2006 to 2010, patients who underwent primary TSA were identified. The prevalence of specific complications was identified using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. The data from this database represent events occurring during admission, prior to discharge. The associations between patient characteristics, complications, and outcomes of TSA were evaluated. The specific outcomes analyzed in this study were mortality and length of stay (LOS).
A total of 125,766 patients were identified. The rate of complication after TSA was 6.7% (8457 patients). The most frequent complications were respiratory, renal, and cardiac, occurring in 2.9%, 0.8%, and 0.8% of cases, respectively. Increasing age and total number of preoperative comorbidities significantly increased the likelihood of having a complication. The prevalence of postoperative shock and central nervous system, cardiac, vascular, and respiratory complications was significantly higher in patients who suffered postoperative mortality (88 patients; 0.07% mortality rate) than in those who survived surgery (P < 0.0001). In terms of LOS, shock and infectious and vascular complications most significantly increased the length of hospitalization.
Postoperative complications following TSA are not uncommon and occur in >6% of patients. Older patients and certain comorbidities are associated with complications after surgery. These complications are associated with postoperative mortality and increased LOS.
