Short-Term Outcomes After Total Shoulder Arthroplasty in Octogenarians: A Matched Analysis

Abstract

IntroductionStudies have shown that the use of total shoulder arthroplasty is increasing every year in the United Stated at a rate higher than that of total hip or total knee arthroplasty. As the population of the United States continues to age, it is becoming more important for surgeons to understand the true impact of age on outcomes and complications following procedures such a total shoulder arthroplasty. The purpose of this study was to determine if octogenarians have poorer outcomes after total shoulder arthroplasty compared to a younger, matched control group. MethodsData was obtained through the American College of Surgeons National Surgical Quality Improvement Program database (ACS NSQIP). Patients who had undergone total shoulder arthroplasty were identified by Current Procedural Terminology code (23472). Indication for arthroplasty was determined by ICD9/10 code (osteoarthritis, fracture, other). Each octogenarian was matched 1:1 to a non-octogenarian based on sex, BMI, ASA class, medical comorbidities, functional status, and surgical indication for arthroplasty by propensity scoring. A subgroup analysis was performed to compare outcomes between only those patients who underwent TSA for osteoarthritis. Outcomes of interest were assessed between the two groups for statistical significance using a chi-squared test or fisher exact test for expected values of less than 5. Statistical significance was set at p<0.05. ResultsAfter matching, octogenarians were found to be at higher risk of readmission (4.7% vs. 3.3%, p=0.046), nonhome discharge (27.1% vs. 9.4%, p<0.001), and overall surgical (4.4% vs. 2.5%, p=0.006) and medical complications (3.7% vs. 2.4%, p=0.039). In the setting of TSA for osteoarthritis only, however, octogenarians were only at higher risk for non-home discharge (22.4% vs. 7.5%, p<0.001). ConclusionsOctogenarians are at higher risk of some complications following total shoulder arthroplasty but fewer than has been previously reported, particularly in the setting of arthroplasty for the treatment of arthritis.

Outcomes of anatomic and reverse total shoulder arthroplasty in patients over the age of 70: a systematic review

“…The 30-day and 90-day mortality of octogenarians in national database studies have been reported to be between 0.22% and 0.5% and 2.7%, respectively. 7,8,42 The overall mortality of all included studies was 19.3%, which is not surprising considering that the mean age of included studies was 79.5 years and the current life expectancy in the United States is 74.2 years for men and 79.9 years for women. 30 Given excellent implant survivorship of both ATSA and RTSA over 98% at 5 years, it is probable that most patients over 70 years will not need a revision procedure.…”

A comprehensive analysis of age and 30-day complications following total shoulder arthroplasty: nonagenarians, octogenarians, and septuagenarians

“…This is in line with prior research, as a study on octogenarian outcomes following TSA found increased risk of non-home discharge compared to nonoctogenarian patients. 5 Nonhome discharge following TSA may negatively impact postoperative outcomes and increase the likelihood of readmission, which raises important considerations for postoperative management of medically complex patients. 20 From age 70, our study also identified age to be a significant predictor of mortality.…”

Clinical outcomes, complications, and survivorship for unicompartmental knee arthroplasty versus total knee arthroplasty in patients aged 80 years and older with isolated medial knee osteoarthritis: a matched cohort analysis

“…With implant survivability currently averaging between 95 and 98% at 3 years [ 24 ], computer-navigated and robot-assisted surgeries, together with a better implant design, may have contributed to recent improvements in the UKA results. The age of 80 years has been identified as a significant threshold at which patients deserve additional evaluation and may have a higher risk of developing adverse outcomes for surgeries including spinal fusion, total shoulder arthroplasty, and revision total hip arthroplasty [ 4 , 5 , 12 , 41 ]. More medical comorbidities, a reduced cardiac reserve, and greater difficulties in maintaining balance are common in older patients [ 44 , 45 ].…”