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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Shoulder arthroplasty risk increased in patients with alcohol abuse

Analysis of perioperative morbidity and mortality in shoulder arthroplasty patients with preexisting alcohol use disorders.

5.4% of adults have been classified as heavier drinkers (women who drink, on average, more than 7 drinks per week; men who drink, on average, more than 14 drinks per week).

These authors used the Nationwide Inpatient Sample, to perform a retrospective cohort study of 422,371 patients undergoing total shoulder arthroplasty or hemiarthroplasty between January 1, 2002, and December 31, 2011. Alcohol use disorder was identified with the following ICD-9-CM codes: 303 (acute alcohol intoxication), 303.9 (unspecified alcohol dependence), 305 (alcohol abuse), and 291 (alcohol-induced mental disorders).

The adverse outcomes for patients with codes for alcohol use disorders were compared to those for patients without these codes.

Patients undergoing shoulder arthroplasty with a preexisting alcohol use disorder had a greater likelihood of death, pneumonia, deep venous thrombosis, acute renal failure, transfusion, prolonged length of stay, and nonroutine discharge irrespective of age, gender, race, and other medical comorbidities. Patients with alcohol use disorder experienced a complication rate of 25.4% compared with 10.9% in those without.

Patients with alcohol use disorder tended to be younger (62 11 years vs 69 11 years), males (63% vs 39%, and of African American descent (4.7% vs 3.1%). They tended to have either Medicaid insurance (8.8% vs 2.5%0) or private insurance (34% vs 26%), and a lower median household income. Importantly, patients with alcohol use disorder tended to have hemiarthroplasty at a significantly higher rate (64% and 40% respectively; P < .001).

Comment: In general, shoulder arthroplasty is an elective procedure. Patients with important risk factors for complications, such as alcohol use disorder, need to advised of the risks and placed on a program to reduce or eliminate the risk as an indication of their commitment to an optimal result.  Patients with alcohol use disorder are less healthy overall, have reduced immune function, are less likely to be compliant with postoperative rehabilitation, and are at greater risk for falls.

The authors of this paper did not compare the shoulder diagnoses between the alcohol use disorder group and the control group. The higher rate of hemiarthroplasty in the former suggests that a higher percentage of patients may have had a diagnosis of fracture in which case the surgery is not elective and there may not be time for a program of risk abatement.

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Consultation for those who live a distance away from Seattle.

Click here to see the new Shoulder Arthritis Book

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To see the topics covered in this Blog, click here

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

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

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Consultation for those who live a distance away from Seattle.

Click here to see the new Shoulder Arthritis Book

Click here to see the new Rotator Cuff Book

To see the topics covered in this Blog, click here

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

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