Friday, August 16, 2013

Complications in total shoulder arthroplasty: relationship to patient health

Predictors of Early Complications of Total Shoulder Arthroplasty

Here again we see authors examining the relationship of the "second of the 4 P s"(the patient) to the results of shoulder joint replacement.

They used the Charlson Comorbidity Index (CCI), a score orginially proposed to predict the ten-year mortality for a patient who may have a range of health conditions. Each condition is assigned a score of 1, 2, 3, or 6, depending on the risk of dying associated with each one:

1 point each: Myocardial infarct, congestive heart failure, peripheral vascular disease, dementia, cerebrovascular disease, chronic lung disease, connective tissue disease, ulcer, chronic liver disease, diabetes.
2 points each: Hemiplegia, moderate or severe kidney disease, diabetes with end organ damage, tumor, leukemia, lymphoma.
3 points each: Moderate or severe liver disease.
6 points each: Malignant tumor, metastasis, AIDS.

The authors of this paper reviewed the 90 day post operative records of 127 patients having total shoulder arthroplasty to see if  age, body mass index (BMI), and / or the Charleson Comorbidiy index could be used to predict early complications after surgery. 
Complications occurred in 12 (9.4%) of patients. Major complications occurred in 1 patient (0.8%), medical complications in 8 (6.3%), and surgical complications in 4 (3.1%). CCI significantly correlated with complication rates (P = 0.005).

Comment: We are paying more and more attention to the overall health of the patient in considering surgical candidacy. In our practice, it would be unusual for individuals with high CCIs to be surgical candidates. There are many conditions other than those listed on the CCI that are important: depression, smoking, fall risk, alcohol consumption, narcotic use, and social support that may be even more relevant to the decision to perform an elective procedure. See VI on the overview page.

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