Sunday, December 14, 2014

How does patient age affect the mortality risk of shoulder arthroplasty?

Patient age is a factor in early outcomes after shoulder arthroplasty.

These authors analyze the Nationwide Inpatient Sample for 58,790 patients undergoing total shoulder arthroplasty or hemiarthroplasty between 2000 and 2008 to determine whether patient age is independently associated with postoperative in-hospital complications or increased hospital charges after shoulder arthroplasty.

They found that patients aged 80 years or older had an increased in-hospital mortality rate (0.5%) compared with patients aged 50 to 79 years (0.1%) and patients aged younger than 50 years (0.1%). 

Factors associated with increased risk of death included female gender, total shoulder arthroplasty versus hemiarthroplasty, and Deyo score. Older patients had longer hospital stays, an increased incidence of postoperative anemia, and slightly higher charges after shoulder arthroplasty.  The authors did not find an increased incidence of other perioperative complications, including pulmonary
embolism and cardiac complications in older individuals.

Comment: In viewing this analysis, we need to recognize that surgeons may be progressively less likely to offer shoulder arthroplasty to progressively older patients. Thus, these data do not represent the mortality or the morbidity risk of all patients with arthritis or fracture that might be treated with arthroplasty, rather the data only represent the subset of patients for whom their surgeons advised that the risk-benefit ratio was favorable.


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