Preoperative indications for total shoulder arthroplasty predict adverse postoperative complications

Abstract

Background Although studies have shown improved pain, function, and patient satisfaction after total shoulder arthroplasty (TSA), preoperative factors predicting poor outcomes are unexplored. Comparison of postoperative complications between osteoarthritis (OA), cuff arthropathy (CA), and fracture patients is important for identifying at-risk patients. Methods Primary TSAs from 2014 to 2016 with preoperative OA, CA, and proximal humerus fractures as indications were queried from the National Surgical Quality Improvement Program database. Short-interval postoperative complications were compared using multivariate binary logistic regression, and postoperative time to discharge between groups was analyzed using univariate analysis of variance with Tukey comparison. Statistical significance was defined as P < .05 using SPSS software version 23.0 (IBM Corp., Armonk, NY, USA). Results Of 9684 TSA cases, the primary indication was OA in 6571 patients, CA in 725 patients, and fractures in 646 patients. Compared with fractures, OA patients had statistically significant lower risk of dislocation, readmission, return to operating room, nonhome discharge, surgical site infection, perioperative bleeding requiring transfusion, and pulmonary embolism (all P < .05). Statistically significant lower risk of dislocation, nonhome discharge, and transfusion was also found between CA and fracture patients (all P < .03). However, in comparing CA vs. OA as preoperative indications, only postoperative venous thromboembolism (odds ratio, 4.5; P = .01) and surgical site infection (odds ratio, 3.7; P = .007) were significant. Mean differences in discharge time were significant between both OA and CA groups compared with fractures ( P < .001), but there was no significance between OA and CA ( P = .116). Conclusion Proximal humerus fracture is a risk factor for increased postoperative complications compared with OA and CA. With new outcomes-based reimbursement models, nonroutine discharge and increased discharge time should be considered in arthroplasty planning.

Projections of Primary and Revision Shoulder Arthroplasty until 2040: Facing a Massive Rise in Fracture-Related Procedures

“…In complex proximal humerus fractures, which represent the third-most common fracture seen in patients aged > 60 years [30], rTSA was found to provide more reproducible function with better recovery, as well as lower revision rates than HA [31,32]. However, recent studies also suggest, that shoulder arthroplasty due to fracture could be associated with more inconsistent outcomes [33,34] and an increased risk of postoperative complications compared with OA and cuff arthropathy [35]. Additionally, shoulder arthroplasty for fracture seems to lead to an even higher resource utilization [36], which is especially important as we documented a massive increase in these procedures in the upcoming decades, probably affecting future healthcare costs.…”

Periprosthetic Infection After Reverse Shoulder Arthroplasty: a Review

“…The indication for surgery has also been shown to be a risk factor for periprosthetic shoulder infection. Multiple studies have shown arthroplasty for treatment of a proximal humerus fracture has a higher risk of PJI, with 3-4 times greater risk compared with other surgical indications [4,35]. Revision shoulder arthroplasty has also been shown to be a risk factor for PJI [9,19].…”

Intraoperative fractures in shoulder arthroplasty: risk factors and outcomes

“…As shoulder arthroplasty becomes an increasingly popular option for patients with degenerative conditions of the shoulder, identifying risk factors for adverse perioperative outcomes remains a priority in this setting. While a wide variety of research studies have examined postoperative outcomes both in terms of functionality and complications, 2 , 6 , 23 , 24 , 25 , 32 few groups have examined the incidence and risk factors for intraoperative fractures. Despite their relative infrequency, patients and providers alike may benefit from this information for use during the preoperative counseling process.…”