Thirty-day Complications and Readmission Rates in Elderly Patients After Shoulder Arthroplasty

Abstract

Introduction:Shoulder arthroplasty procedures are increasingly being performed in older patients despite an increased perioperative risk. The purpose of this study is to determine the complications and 30-day readmission rates in the elderly population after shoulder arthroplasty and hemiarthroplasty.Methods:Total shoulder arthroplasty, reverse total shoulder arthroplasty, and hemiarthroplasty cases were collected from the National Surgical Quality Improvement Program database from 2006 to 2015. The 30-day complication and readmission rates, surgical time, discharge destination, and total hospital length of stay were calculated, comparing patients by age (elderly: ≥80 years; older: 65 to 79 years; younger: <65 years). Multivariable logistic regression analysis was performed to identify variables associated with any complication within 30 days of surgery.Results:Of 11,450 patients, 1,956 (17.1%) underwent shoulder hemiarthroplasty and 9,494 (82.9%) underwent total shoulder arthroplasty. By age group, 1,708 (14.9%) were ≥80, 6,073 (53.0%) were 65 to 79, and 3,669 (32.0%) were <65. The overall 30-day postoperative complication rate was significantly higher in elderly patients (15.3% versus 8.2% versus 6.8%; P < 0.001), length of stay (2.6 versus 2.1 versus 1.8 days; P < 0.001), and unplanned readmissions (5.5% versus 2.6% versus 2.3%; P < 0.001). The strongest independent variables significantly associated with any complication included revision arthroplasty indication (odds ratio [OR], 4.34; P < 0.001), fracture indication (OR, 4.14; P < 0.001), and history of cardiac disease (OR, 2.33; P < 0.001), followed by elderly age (OR, 2.01; P < 0.001).Conclusions:The 15.3% complication rate (major, 4.8%; minor, 10.7%), 2.6 days of average length of stay, and 5.5% unplanned readmission among elderly patients (>80) are significantly higher than younger patients. Although surgical indications and comorbidities are higher-quality predictors of complications, elderly patients should be appropriately counseled and medically optimized according to the perioperative risk profile before surgery.

Primary reverse total shoulder arthroplasty in patients older than 80 years: clinical and radiologic outcome measures

“…These complication rates resulted in very low reoperation rates between 0 and 2%. [17][18][19] Clark et al 5 described an overall mortality of 19% in the median time to death of 67.7 months in the study population. The data are promising and lend support to RTSA for elderly patients.…”

Demographic and clinical factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty: a retrospective cohort study

“…With approximately 70,000 surgeries each year, TSA has become the fastest growing total joint replacement procedure in the United States [ 1 , 2 ]. The number of procedures is expected to further increase given the aging population and the notable success of TSA procedures in restoring function and reducing pain [ 3 , 4 ]. TSA procedures are used to treat various degenerative conditions of the shoulder common in older adult populations [ 4 , 5 ].…”

“…The number of procedures is expected to further increase given the aging population and the notable success of TSA procedures in restoring function and reducing pain [ 3 , 4 ]. TSA procedures are used to treat various degenerative conditions of the shoulder common in older adult populations [ 4 , 5 ].…”

Patient Complications after Interscalene Block: A Retrospective Comparison of Liposomal Bupivacaine to Nonliposomal Bupivacaine

“…Shin et al performed a large database study on 27,072 shoulder arthroscopies and found a surgical complication rate of 7.9% and block-related complication rate of 0.59% [21]. Koh et al evaluated 11,450 shoulder arthroplasty patients finding a complication rate of 7.6% [22]. While the rate of complications seen in our study is similar to the large database meta-analyses [20][21][22], all are still lower than described by Vandepitte et al who compared liposomal bupivacaine added to bupivacaine vs. bupivacaine interscalene blocks [16].…”

“…Koh et al evaluated 11,450 shoulder arthroplasty patients finding a complication rate of 7.6% [22]. While the rate of complications seen in our study is similar to the large database meta-analyses [20][21][22], all are still lower than described by Vandepitte et al who compared liposomal bupivacaine added to bupivacaine vs. bupivacaine interscalene blocks [16]. ey found that 17 out of 26 patients in the liposomal bupivacaine group reported adverse events compared to 10 out of 24 in the bupivacaine group.…”