Wednesday, June 20, 2018

Revision arthroplasty: risky business

Risk factors for and timing of adverse events after revision total shoulder arthroplasty 

These authors sought to identify risk factors for unplanned readmission and perioperative complications following revision total shoulder arthroplasty, risk-stratify patients based on these risk factors, and assess timing of complications in patients from the ACS-NSQIP database from 2011 to 2015.

Of 809 revision patients, 61 suffered a perioperative complication or readmission within 30 days of discharge. Multivariate analysis identified operative time, BMI>40, infection etiology, high white blood cell count, and low hematocrit as significant independent risk factors for 30-day complications or readmission after revision surgery. 

Having at least one significant risk factor was associated with 2.71 times risk of complication or readmission within 15 days compared to having no risk factors. The majority of unplanned readmission, return to the operating room, open/deep wound infection, and sepsis/septic shock occurred within two weeks of revision surgery. 

Comment: We are often tempted to "fix" a failed shoulder arthroplasty. This article reminds us that there are major risks of revision, especially in patients with the factors identified. The less healthy the patient, the greater the risk of complications and readmissions.

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