Reverse Total Shoulder Arthroplasty in Obese Patients

Beck, John D.; Irgıt, Kaan; Andreychik, Cassondra M.; Maloney, Patrick J.; Tang, Xiaoqin; Harter, G Dean

doi:10.1016/j.jhsa.2013.02.025

Cited by 67 publications

(54 citation statements)

References 26 publications

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“…Although neither Chalmers et al [8] or Beck et al [5] found obesity to affect surgical time in a series of patients undergoing TSA and reverse TSA respectively [5,8], our results are in accordance with those of Linberg et al [24], who reported prolonged operative time in patients who were obese who were undergoing TSA. Similarly, increased operative time has been reported in patients who are obese who are undergoing arthroscopic procedures about the shoulder [30].…”

Section: Discussionsupporting

confidence: 88%

“…Previous studies have shown inconsistent results regarding the association of obesity on complications in upper extremity arthroplasty [3,5,13,14,27,31]. Some smaller reviews have reported an increase in associated complications [3,5,14], whereas studies with larger sample sizes have shown no such relationship [13,27,31]. In a review of reverse TSAs, Beck et al [5] found that the coexistence of obesity was associated with increased complications.…”

Section: Discussionmentioning

confidence: 99%

“…Some smaller reviews have reported an increase in associated complications [3,5,14], whereas studies with larger sample sizes have shown no such relationship [13,27,31]. In a review of reverse TSAs, Beck et al [5] found that the coexistence of obesity was associated with increased complications. Similarly, Gupta et al [14] reported that patients with a BMI greater than 35 mg/m 2 had a higher proportion of complications in a retrospective review of 119 patients.…”

Section: Discussionmentioning

confidence: 99%

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Obesity is Not Associated with Increased Short-term Complications After Primary Total Shoulder Arthroplasty

Jiang

Somogyi

Patel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Few studies have analyzed the association between elevated BMI and complications after total shoulder arthroplasty (TSA). Previous studies have not consistently arrived at the same conclusion regarding whether obesity is associated with a greater number of postoperative complications. We used a national surgical database to compare the 30-day complication profile and hospitalization outcomes after primary TSA among patients in different BMI categories. Questions/purposes We asked: (1) Is obesity associated with an increased risk of complications within 30 days of primary TSA? (2) Is obesity associated with increased operative time? Methods The American College of Surgeons National Surgical Quality Improvement Program 1 database for 2006 to 2012 was queried to identify all patients who underwent a primary TSA for osteoarthritis of the shoulder. The ACS-NSQIP 1 database was selected for this study as it is a nationally representative database that provides prospectively collected perioperative data and a comprehensive patient medical profile. Exclusion criteria included revision TSA, infection, tumor, or fracture. We analyzed 4796 patients who underwent a primary TSA for osteoarthritis of the shoulder. Patients who underwent a TSA were divided in four BMI categories: normal (18.5-25 kg/m 2 ), overweight (25-30 kg/m 2 ), obesity Class 1 (30-35 kg/m 2 ), and obesity Class 2 or greater ([ 35 kg/m 2 ). Perioperative hospitalization data and 30-day postoperative complications were compared among different BMI classes. Differences in patient demographics, preoperative laboratory values, and preexisting patient comorbidities also were analyzed among different BMI groups, and multivariate analysis was used to adjust for any potential confounding variables.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Obesity is Not Associated with Increased Short-term Complications After Primary Total Shoulder Arthroplasty

Jiang

Somogyi

Patel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Patel et al suggested that shoulder skin region has a greater bacterial load of P acnes compared with other body regions and this may be sexrelated [12]. Studies have reported infection rates for shoulder arthroplasty of approximately 1%, with reverse total shoulder arthroplasty having the highest rate [1,2,[16][17][18]20]. We found that when evaluating patients who had total shoulder arthroplasties and reverse total shoulder arthroplasties separately, 0.7% of those having a total shoulder arthroplasty had an infection develop compared with 2.2% of patients having a reverse total shoulder arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Patient and Procedure-specific Risk Factors for Deep Infection After Primary Shoulder Arthroplasty

Richards

Inacio

Beckett

et al. 2014

Clinical Orthopaedics &Amp; Related Research

192

122

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Background Deep infection after shoulder arthroplasty is a diagnostic and therapeutic challenge. The current literature on this topic is from single institutions or Medicare samples, lacking generalizability to the larger shoulder arthroplasty population. Questions/purposes We sought to identify (1) patientspecific risk factors for deep infection, and (2) the pathogen profile after primary shoulder arthroplasty in a large integrated healthcare system. Methods A retrospective cohort study was conducted. Of 4528 patients identified, 320 had died and 302 were lost to followup. The remaining 3906 patients had a mean followup of 2.7 years (1 day-7 years). The study endpoint was the diagnosis of deep infection, which was defined as revision surgery for infection supported clinically by more than one of the following criteria: purulent drainage from the deep incision, fever, localized pain or tenderness, a positive deep culture, and/or a diagnosis of deep infection made by the operating surgeon based on intraoperative findings. Risk factors evaluated included age, sex, race, BMI, diabetes status, American Society for Anesthesiologists (ASA) score, traumatic versus elective procedure, and type of surgical implant. For patients with deep infections, we reviewed the surgical notes and microbiology records for the pathogen profile. Multivariable Cox regression models were used to evaluate the association of risk factors and deep infection. Adjusted hazard ratios and 95% CI are presented. Results With every 1-year increase in age, a 5% (95% CI, 2%-8%) lower risk of infection was observed. Male patients had a risk of infection of 2.59 times (95% CI, 1.27-5.31) greater than female patients. Patients undergoing primary reverse total shoulder arthroplasty had a 6.11 times (95% CI, 2.65-14.07) greater risk of infection compared with patients having primary unconstrained total shoulder arthroplasty. Patients having traumatic arthroplasties were Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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“…Finally, the higher BMI in the younger cohort may confound this finding, although the impact of BMI on complications after shoulder arthroplasty is still to be determined. [13][14][15][16][17] In terms of the implications of our findings on health care delivery, a couple of points merit consideration. First is the finding of a greater than 9% readmission rate for patients who underwent RTSA regardless of comorbidities and a readmission rate above 7% in elderly patients who underwent TSA.…”

Section: Original Research and Contributionsmentioning

confidence: 99%

Effect of Age on Outcomes of Shoulder Arthroplasty

Anakwenze

Yehyawi

Dillon

et al. 2017

TPJ

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Context: Outcomes of total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) as a function of age are not well known.Objective: To understand the effects of age on revision rate, mortality, and hospital readmissions.Design: A retrospective cohort study of prospectively collected data. Using an integrated health care system's shoulder arthroplasty registry, we identified patients who underwent TSA and RTSA between January 2007 and June 2012. Patients were grouped into older (> 75 years) and younger groups (≤ 75 years).Main Outcome Measures: Differences in outcomes between both age groups.Results: The TSA cohort had 2007 patients, and 538 (26.8%) were older than age 75 years. Older patients who underwent TSA had higher risks of 1-year mortality (2.0% vs 0.6%; odds ratio = 3.34, 95% confidence interval [CI] = 1.00-11.11, p = 0.049) and readmission within 90 days (7.6% vs 4.4%; odds ratio = 1.75, 95% CI = 1.17-2.63, p = 0.007). The RTSA cohort had 568 patients, and 295 (51.9%) of them were older than age 75 years. Older RTSA patients had a lower risk of revision (3.7% vs 8.1%; hazard ratio = 0.45, 95% CI = 0.24-0.89, p = 0.020).Conclusion: Patient age is one of many important variables that surgeons should consider when performing shoulder arthroplasty. However, the impact of age in the TSA and RTSA populations is different. In the TSA cohort, older patients have higher risk of readmission and mortality. In the RTSA cohort, older patients have lower risk of revision.

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Reverse Total Shoulder Arthroplasty in Obese Patients

Cited by 67 publications

References 26 publications

Obesity is Not Associated with Increased Short-term Complications After Primary Total Shoulder Arthroplasty

Obesity is Not Associated with Increased Short-term Complications After Primary Total Shoulder Arthroplasty

Patient and Procedure-specific Risk Factors for Deep Infection After Primary Shoulder Arthroplasty

Effect of Age on Outcomes of Shoulder Arthroplasty

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