Short-Term Complications and Readmission Following Total Shoulder Arthroplasty: A National Database Study
نویسندگان
1 Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
2 Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
3 Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
4 Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
5 Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
doi
10.22038/abjs.2020.48852.2426چکیده
Background: The incidence of total shoulder arthroplasty (anatomic and reverse) is increasing as indications expand.The purpose of this study is to identify predictors of short-term complications and readmission following total shoulderarthroplasty for patients with glenohumeral osteoarthritis.Methods: The American College of Surgeons National Surgical Quality Improvement Program was used to identify12,982 patients who underwent total shoulder arthroplasty (anatomic or reverse) from 2011-2016. Demographic data,postoperative complications, and readmission within 30 days were analyzed. Multivariable logistic regression was usedto determine independent risk factors for complications and for readmission occurring within 30 days of surgery.Results: The mean age of the cohort was 69.1 years, 56.1% were female. Mean American Society ofAnesthesiologists (ASA) classification score was 2.6. The postoperative complication rate was 5.6% and thereadmission rate was 2.8% within 30 days of surgery. Independent predictors for any complication includedpreoperative dependent functional status (OR 1.8, p <0.001), ASA class 3 (OR 3.6, P=0.021) and 4 (OR 8.5,p <0.001), age 70-79 (OR 1.4, P=0.019) age ≥ 80 years (OR 2.3, p <0.001, and female gender (OR 1.6, P=0.001).Independent predictors for readmission included congestive heart failure (OR 3.4, P=0.002) and ASA class 4(OR 14, P = 0.013). Independent functional status was associated with decreased odds of readmission (OR 0.4,p <0.001).Conclusion: Patients with age greater than 70 years, congestive heart failure, and ASA class 3 and 4 are at increasedrisk for postoperative complications and readmission. Preoperative risk stratification and medical optimization areimportant in these patients.Level of evidence: III
