Friday, November 28, 2014

Total shoulder complications: 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 identifying 2004 patients having primary total shoulder arthroplasty between 2006 and 2011. The average age was 69 years, and 57% were women. The 30-day mortality and total complication rates were 0.25% and 3.64%, respectively. Severe complications included postoperative sepsis, thromboembolism, cerebrovascular event, and cardiac arrest.

Cardiac disease (congestive heart failure or history of myocardial infarction), increasing age, and peripheral vascular disease were associated with increased risk of complications. Cardiac disease had an odds ratio of 85 for complications. The odds of death increased 2-fold for each decade in increased age. Peripheral vascular disease was associated with a more than 6-fold greater risk of any postoperative complication. Operative times over174 minutes were also associated with a 4-fold increased incidence of major local complications.

Comment: This study is helpful in indicating the patients what require special preoperative counseling, medical consultation, and close surveillance in order to make total shoulder arthroplasty as safe as possible.


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