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

Background Despite increasing rates of revision total shoulder arthroplasty (RTSA), there is a paucity of literature on optimizing perioperative outcomes. The purposes of this study were to identify risk factors for unplanned readmission and perioperative complications following RTSA, risk-stratify patients based on these risk factors, and assess timing of complications. Methods Bivariate and multivariate analyses of risk factors were assessed on RTSA patients from the ACS-NSQIP database from 2011 to 2015. Patients were risk-stratified and timing of severe adverse events and cause of readmission were evaluated. Results Of 809 RTSA 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 RTSA (p ≤ 0.05). 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 (p < 0.001). The majority of unplanned readmission, return to the operating room, open/deep wound infection, and sepsis/septic shock occurred within two weeks of RTSA. Discussion Patients at high risk of complications and readmission after RTSA should be identified and optimized preoperatively to improve outcomes and lower costs.

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Impact of operative time on short-term adverse events following total shoulder arthroplasty

Seminars in Arthroplasty ◽

10.1053/j.sart.2020.07.007 ◽

2020 ◽

Vol 30 (3) ◽

pp. 227-236

Author(s):

Kevin I. Kashanchi ◽

Alireza K. Nazemi ◽

David E. Komatsu ◽

Edward D. Wang

Keyword(s):

Adverse Events ◽

Shoulder Arthroplasty ◽

Operative Time ◽

Total Shoulder Arthroplasty ◽

Short Term

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Risk factors for failing to achieve improvement after anatomic total shoulder arthroplasty for glenohumeral osteoarthritis

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2017.12.018 ◽

2018 ◽

Vol 27 (6) ◽

pp. 968-975 ◽

Cited By ~ 20

Author(s):

Gregory T. Mahony ◽

Brian C. Werner ◽

Brenda Chang ◽

Brian M. Grawe ◽

Samuel A. Taylor ◽

...

Keyword(s):

Risk Factors ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Glenohumeral Osteoarthritis

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Acromial fracture after reverse total shoulder arthroplasty: a systematic review

Shoulder & Elbow ◽

10.1177/1758573219876486 ◽

2019 ◽

Vol 12 (6) ◽

pp. 375-389 ◽

Cited By ~ 2

Author(s):

Simon C Lau ◽

Richard Large

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Stress Fracture ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Revision Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Cochrane Library ◽

Acromial Fracture ◽

Reverse Total Shoulder

Background The reverse total shoulder arthroplasty has become the most common method of arthroplasty of the shoulder. The complication of acromial or scapular stress fracture deserves consideration to describe incidence and determine whether prosthetic design or patient factors act as risk factors. Methods A systematic review of the literature was performed including the EMBASE, Medline and the Cochrane Library in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results The search returned 565 articles. After exclusion, 25 papers remained. In total, 208 fractures were reported in the literature, with an overall incidence of 5% and stress fractures were more common than post-traumatic ones; 24 fractures underwent osteosynthesis and there were nine revision arthroplasty surgeries. Outcomes worsened after fracture – whether treated with surgery or not. In patients with scapular base fractures, there was an improvement in functional outcome scores after surgery. Heterogeneous reporting of the risk factors prior to fractures, treatment methods and outcomes made recommendations weak. Discussion Acromial stress fracture after reverse total shoulder arthroplasty occurs relatively commonly but is poorly reported in the literature. It is unclear whether immobilisation, fixation or revision arthroplasty is the best treatment, although fixation may offer a better outcome. In future, reports should aim for greater consistency to allow a better understanding of this condition.

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Incidence and risk factors for aseptic baseplate loosening of reverse total shoulder arthroplasty

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2018.05.034 ◽

2018 ◽

Vol 27 (12) ◽

pp. 2145-2152 ◽

Cited By ~ 16

Author(s):

Alexander Bitzer ◽

Jorge Rojas ◽

Ian S. Patten ◽

Jacob Joseph ◽

Edward G. McFarland

Keyword(s):

Risk Factors ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Reverse Total Shoulder

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Incidence, risk factors, and clinical impact of non-home discharge following surgical management of proximal humerus fractures

Shoulder & Elbow ◽

10.1177/1758573218809505 ◽

2018 ◽

Vol 11 (6) ◽

pp. 430-439

Author(s):

Azeem T Malik ◽

Jonathan D Barlow ◽

Nikhil Jain ◽

Safdar N Khan

Keyword(s):

Risk Factors ◽

Shoulder Arthroplasty ◽

Proximal Humerus ◽

Total Shoulder Arthroplasty ◽

Open Reduction Internal Fixation ◽

Clinical Impact ◽

Proximal Humerus Fractures ◽

Factors Associated ◽

Discharge Disposition ◽

Humerus Fractures

Introduction There has been a reported increase in the number of proximal humerus fractures being surgically managed. In an attempt to manage increasing costs associated with increasing volume, there is a need for identification of factors associated with discharge destinations. Methods The 2012–2016 American College of Surgeons—National Surgical Quality Improvement Program database was queried using Current Procedural Terminology codes for open reduction internal fixation, hemiarthroplasty, and total shoulder arthroplasty being performed for proximal humerus fractures. Results Five hundred and seventy-six (21.5%) patients had nonhome discharge disposition. Following adjusted analysis, age > 65 years (p < 0.001), partially dependent functional health status prior to surgery(p = 0.027), inpatient surgery (p = 0.010), American Society of Anesthesiologists (ASA) grade>II (p < 0.001), transfer from nursing home/chronic care facility (p < 0.001), undergoing a total shoulder arthroplasty versus open reduction internal fixation (p = 0.012), length of stay > 2 days (p < 0.001), and the occurrence of any predischarge complication (p < 0.001) were significant predictors associated with a nonhome discharge disposition. Conclusion The study identifies significant risk factors associated with a nonhome discharge and assesses clinical impact of nonhome discharge destination on postdischarge outcomes. Providers can utilize these data to preoperatively risk stratify those at an increased risk of a nonhome discharge, counsel patients on discharge expectations, and tailor a more appropriate postoperative course of care.

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Risk factors for venous thromboembolism in total shoulder arthroplasty

JSES Open Access ◽

10.1016/j.jses.2019.07.003 ◽

2019 ◽

Vol 3 (3) ◽

pp. 183-188

Author(s):

Brandon E. Lung ◽

Shrey Kanjiya ◽

Michael Bisogno ◽

David E. Komatsu ◽

Edward D. Wang

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty

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Comparison of surgical and non-surgical treatments for 3- and 4-part proximal humerus fractures: A network meta-analysis

Shoulder & Elbow ◽

10.1177/1758573219831506 ◽

2019 ◽

Vol 12 (2) ◽

pp. 99-108 ◽

Cited By ~ 1

Author(s):

Sebastian Orman ◽

Amin Mohamadi ◽

Joseph Serino ◽

Jordan Murphy ◽

Philip Hanna ◽

...

Keyword(s):

Surgical Treatment ◽

Adverse Events ◽

Shoulder Arthroplasty ◽

Open Reduction ◽

Proximal Humerus ◽

Total Shoulder Arthroplasty ◽

Open Reduction Internal Fixation ◽

Reverse Total Shoulder Arthroplasty ◽

Reverse Total Shoulder ◽

Non Surgical Treatment

Introduction Common treatment strategies for proximal humerus fractures include non-surgical treatment, open reduction internal fixation, hemiarthroplasty, and reverse total shoulder arthroplasty. There is currently no consensus regarding the superiority of any one surgical strategy. We used network meta-analysis of randomized controlled trials to determine the most successful treatment for proximal humerus fractures. Methods MEDLINE, EMBASE, Web of Science, and Cochrane Central electronic databases were searched for randomized controlled trials comparing 3- and 4-part proximal humerus fracture treatments. Data extraction included the mean and standard deviation of clinical outcomes (Constant, DASH), adverse events, and additional surgery rates. Standard Mean Difference was used to compare clinical outcome scores, and pooled risk ratios were used to compare adverse events and additional surgeries. Results Eight randomized controlled trials were included for network meta-analysis. Non-surgical treatment was associated with a lower rate of additional surgery and adverse events compared to open reduction internal fixation. Reverse total shoulder arthroplasty resulted in fewer adverse events and a better clinical outcome score than hemiarthroplasty. Non-surgical treatment produced similar clinical scores, adverse event rates, and additional surgery rates to hemiarthroplasty and reverse total shoulder arthroplasty. Conclusion Non-surgical treatment results in fewer complications and additional surgeries compared to open reduction internal fixation. Preliminary data supports reverse total shoulder arthroplasty over hemiarthroplasty, but more evidence is needed to strengthen this conclusion.

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