An Analysis of Adult Patient Risk Factors and Complications Within 30 Days After Arthroscopic Shoulder Surgery

Background:Surgical intervention for anterior shoulder instability is commonly performed and is highly successful in reducing instances of recurrent instability.Purpose:To determine and compare the incidence of 30-day complications and patient and surgical risk factors for complications for arthroscopic Bankart, open Bankart, and Latarjet-Bristow procedures.Study Design:Cohort study; Level of evidence, 3.Methods:All arthroscopic Bankart, open Bankart, and Latarjet-Bristow procedures from 2005 to 2014 from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) prospective database were analyzed. Baseline patient variables were assessed, including the Charlson Comorbidity Index (CCI). Outcomes measures included length of operation, length of hospital stay, need for hospital admission, 30-day readmission, and 30-day return to the operating room. Binary logistic regression was performed for the presence of any complications after all 3 procedures.Results:There were 2864 surgical procedures (410 open Bankart, 163 Latarjet-Bristow, and 2291 arthroscopic Bankart) included. There was no significant difference with regard to age (P = .11), body mass index (P = .17), American Society of Anesthesiologists class (P = .423), or CCI (P = .479) for each group. The Latarjet-Bristow procedure had the highest overall complication rate (5.5%) compared with open (1.0%) and arthroscopic (0.6%) Bankart repairs. The Latarjet-Bristow procedure had significantly longer mean operative times (P < .001) in addition to the highest 30-day return rate to the operating room (4.3%; 95% confidence interval, 1.2%-7.4%). Smoking status was an independent predictor of a postoperative complication (P = .05; odds ratio, 8.0) after Latarjet-Bristow.Conclusion:Surgical intervention for anterior shoulder instability has a low rate of complication (arthroscopic Bankart, 0.6%; open Bankart, 1.0%; Latarjet-Bristow, 5.5%) in the early postoperative period, with the most common being surgical site infection, deep vein thrombosis, and return to the operating room.

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“…Overall, the NSQIP has been shown in the literature to be a high-quality database to study perioperative complications. 8,15,16,23,24,36,38 …”

Section: Discussionmentioning

confidence: 99%

Comparison of 30-Day Morbidity and Mortality After Arthroscopic Bankart, Open Bankart, and Latarjet-Bristow Procedures: A Review of 2864 Cases

Bokshan

DeFroda

Owens

2017

Orthopaedic Journal of Sports Medicine

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“…44 45 The studies included 15 015 44 and 10 225 45 patients, both at low risk of bias (online supplementary appendix table 7). The incidence of serious harms following mixed shoulder arthroscopic procedures during 2006-2011 was 0.5% (0.4%-0.7%) 45 and during 2011-2013 was 0.6% (0.5%-0.7%). 44 Online supplementary appendix table 8 presents the details of harms.…”

Section: Harmsmentioning

confidence: 98%

“…One report noted that harms from 'major' or 'repair' procedures were similar to harms for 'minor' or 'non-repair' procedures (adjusted OR 0.77, 95% CI 0.48 to 1.22). 45 Because these studies reported results from a variety of arthroscopic shoulder procedures, many of which take longer to perform, we rated down the evidence to moderate certainty.…”

Section: Harmsmentioning

confidence: 99%

Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis

Lähdeoja¹,

Karjalainen²,

Jokihaara³

et al. 2019

Br J Sports Med

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“…This database is a highly accurate source of information regarding postoperative admission, patient demographics, and medical comorbidities and has been validated for many orthopedic procedures to date, including anterior cruciate ligament reconstruction. 12,[14][15][16][17][18][19][20][21][22][23]…”

Section: Source Datamentioning

confidence: 99%

“…The NSQIP database has been previously used to study short-term postoperative complications for several orthopedic procedures. [10][11][12][13][14][15][16][17][18][19] The authors hypothesized that patients with a higher number of medical comorbidities, older age, and longer surgical time would be more likely to be admitted following Bankart repair.…”

mentioning

confidence: 99%

Risk Factors for Hospital Admission Following Arthroscopic Bankart Repair

DeFroda¹,

Bokshan²,

Owens³

2017

Orthopedics

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Arthroscopic Bankart repair, a commonly performed procedure in the United States, is usually done on an outpatient basis. All instances of arthroscopic Bankart repair from 2005 to 2014 from the American College of Surgeons National Surgical Quality Improvement Program prospective database were analyzed. Both univariate analysis and binary logistic regression were performed to determine risk factors for admission following surgery. Of 2291 patients undergoing arthroscopic Bankart repair, 173 (7.6%) required inpatient hospital admission following surgery. Univariate analysis found the following to be associated with admission: female sex (P=.009), age older than 40 years (P<.001), white race (P=.002), body mass index greater than 30 kg/m (P=.001), and American Society of Anesthesiologists class greater than 3 (P<.001). Independent predictors of admission on multivariate analysis included female sex (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.06-2.10; P=.023), increasing age (per year) (OR, 1.03; 95% CI, 1.02-1.04; P<.001), diabetes (OR, 2.70; 95% CI, 2.30-3.10; P=.006), and longer operation time (per minute) (OR, 1.010; 95% CI, 1.009-1.011; P<.001). This study identified a 7.6% rate of admission following arthroscopic Bankart repair, with diabetes, female sex, increasing age, and longer operation time being independent risk factors for admission. Knowledge of these risk factors is important when setting patient expectations preoperatively and for optimizing care to obtain the best short-term outcome. [Orthopedics. 2017; 40(5):e855-e861.].

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An Analysis of Adult Patient Risk Factors and Complications Within 30 Days After Arthroscopic Shoulder Surgery

Cited by 62 publications

References 26 publications

Comparison of 30-Day Morbidity and Mortality After Arthroscopic Bankart, Open Bankart, and Latarjet-Bristow Procedures: A Review of 2864 Cases

Comparison of 30-Day Morbidity and Mortality After Arthroscopic Bankart, Open Bankart, and Latarjet-Bristow Procedures: A Review of 2864 Cases

Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis

Risk Factors for Hospital Admission Following Arthroscopic Bankart Repair

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