Thursday, September 25, 2014

Death and morbidity after total shoulder arthroplasty - risk factors

Thirty-day morbidity and mortality after elective total shoulder arthroplasty: patient-based and surgical risk factors.

These authors queried the National Surgical Quality Improvement Program database to identify all patients undergoing primary TSA between 2006 and 2011, extracting selected patient and surgical variables along with the 30-day clinical course.

2004 patients with total shoulders were identified with an average age of 69 years. 57% were women. 46% were obese and 48% had an American Society of Anesthesiologists (ASA) classification of ≥3. The 30-day mortality and total complication rates were 0.25% and 3.64%, respectively.

Comorbid cardiac disease and increasing age were independent predictors of mortality. Complications were increased 6 fold in the presence of peripheral vascular disease and 4 fold when operative time was 3 or more hours. The most common surgical complications were infection and peripheral nerve injury. 

Obesity was not a significant risk factor.

Comment: This study reveals that total shoulders are often performed on individuals who are not in good health. Almost half were classified as having an ASA class reflecting "severe or life-threatening disturbance" of their health. Over 2/3 rds had hypertension, 16% had diabetes, and 11% had major cardiac issues.
Patients with such factors deserve special counseling regarding the risk of complications and special surveillance for the occurrence of adverse events, such as pulmonary emboli, sepsis, strokes, cardiac events and renal failure