Does the sequence and timing of total shoulder arthroplasty relative to lower extremity arthroplasty influence postoperative complications?

Background: Recent research has found a high rate of emergency department (ED) use after lower extremity arthroplasty; one study found a risk factor for ED presentation after lower extremity arthroplasty was presentation to the ED in the year prior to surgery. It is not known whether a similar association exists for total shoulder arthroplasty (TSA). Questions/Purposes: The goal of this study was to investigate the relationship between preoperative ED visits and postoperative ED visits after anatomic TSA. Methods: The 100% Medicare database was queried for patients who underwent anatomic TSA from 2005 to 2014. Emergency department visits within the year prior to the date of TSA were identified. Patients were additionally stratified by the number and timing of preoperative ED visits. The primary outcome measure was one or more postoperative ED visits within 90 days. A multivariate logistic regression analysis was used to control for patient demographics and comorbidities. Results: Of the 144,338 patients identified, 32,948 (22.8%) had an ED visit in the year prior to surgery. Patients with at least 1 ED visit in the year before surgery presented to the ED at a significantly higher rate than patients without preoperative ED visits (16% versus 6%). An ED visit in the year prior to TSA was the most significant risk factor for postoperative ED visits (in the multivariate analysis). The number of preoperative ED visits in the year prior to surgery demonstrated a significant dose-response relationship with increasing risk of postoperative ED visits. Conclusions: Postoperative ED visits occurred in nearly 10% of Medicare patients who underwent TSA in the period studied. More frequent presentation to the ED in the year prior to anatomic TSA was associated with increasing risk of postoperative ED visits. Future studies are needed to investigate the reasons for preoperative ED visits and if any modifiable risk factors are present to improve the ability to risk stratify and optimize patients for elective TSA.

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Development of a Machine Learning Algorithm for Prediction of Complications and Unplanned Readmission Following Reverse Total Shoulder Arthroplasty

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/24715492211038172 ◽

2021 ◽

Vol 5 ◽

pp. 247154922110381

Author(s):

Sai K. Devana ◽

Akash A. Shah ◽

Changhee Lee ◽

Varun Gudapati ◽

Andrew R. Jensen ◽

...

Keyword(s):

Machine Learning ◽

Postoperative Complications ◽

Postoperative Complication ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Gradient Boosting ◽

Major Postoperative Complication ◽

Reverse Total Shoulder ◽

Continuous And Discrete Variables

Background Reverse total shoulder arthroplasty (rTSA) offers tremendous promise for the treatment of complex pathologies beyond the scope of anatomic total shoulder arthroplasty but is associated with a higher rate of major postoperative complications. We aimed to design and validate a machine learning (ML) model to predict major postoperative complications or readmission following rTSA. Methods We retrospectively reviewed California's Office of Statewide Health Planning and Development database for patients who underwent rTSA between 2015 and 2017. We implemented logistic regression (LR), extreme gradient boosting (XGBoost), gradient boosting machines, adaptive boosting, and random forest classifiers in Python and trained these models using 64 binary, continuous, and discrete variables to predict the occurrence of at least one major postoperative complication or readmission following primary rTSA. Models were validated using the standard metrics of area under the receiver operating characteristic (AUROC) curve, area under the precision–recall curve (AUPRC), and Brier scores. The key factors for the top-performing model were determined. Results Of 2799 rTSAs performed during the study period, 152 patients (5%) had at least 1 major postoperative complication or 30-day readmission. XGBoost had the highest AUROC and AUPRC of 0.681 and 0.129, respectively. The key predictive features in this model were patients with a history of implant complications, protein-calorie malnutrition, and a higher number of comorbidities. Conclusion Our study reports an ML model for the prediction of major complications or 30-day readmission following rTSA. XGBoost outperformed traditional LR models and also identified key predictive features of complications and readmission.

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Preoperative indications for total shoulder arthroplasty predict adverse postoperative complications

JSES Open Access ◽

10.1016/j.jses.2019.03.003 ◽

2019 ◽

Vol 3 (2) ◽

pp. 99-107 ◽

Cited By ~ 2

Author(s):

Brandon E. Lung ◽

Shrey Kanjiya ◽

Michael Bisogno ◽

David E. Komatsu ◽

Edward D. Wang

Keyword(s):

Postoperative Complications ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty

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Occult thoracoacromial artery injury during reverse total shoulder arthroplasty resulting in a cascade of postoperative complications: A case report

Radiology Case Reports ◽

10.1016/j.radcr.2020.07.004 ◽

2020 ◽

Vol 15 (9) ◽

pp. 1657-1662

Author(s):

Young Min Noh ◽

Hyun Su Do ◽

Si Young Heo

Keyword(s):

Case Report ◽

Postoperative Complications ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Thoracoacromial Artery ◽

Artery Injury ◽

Reverse Total Shoulder

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Thirty-day morbidity and mortality following revision total shoulder arthroplasty in octogenarians

Shoulder & Elbow ◽

10.1177/17585732211027334 ◽

2021 ◽

pp. 175857322110273

Author(s):

Puneet Gupta ◽

Theodore Quan ◽

Zachary R Zimmer

Keyword(s):

Pulmonary Embolism ◽

Postoperative Complications ◽

Length Of Stay ◽

Shoulder Arthroplasty ◽

Multivariate Analyses ◽

Total Shoulder Arthroplasty ◽

Morbidity And Mortality ◽

Old Patients ◽

Increased Risk ◽

Extended Length

Background Octogenarians are at an increased risk of morbidity and mortality following various surgeries, but this has not yet been well explored in octogenarians undergoing revision total shoulder arthroplasty (RTSA). Thus, the purpose of this study was to analyze whether octogenarians undergoing RTSA are at an increased risk of 30-day postoperative complications, readmissions, and mortality relative to the younger geriatric population. Methods Data of patients who underwent RTSA from 2013 to 2018 were obtained from a large de-identified database. Patients were divided into two cohorts: ages 65–79 and ages 80–89. Demographic data, comorbidities, and postoperative complications were collected and compared between the two cohorts. Bivariate and multivariate analyses were performed. Results On bivariate analyses, patients aged 80–89 were more likely to develop pulmonary embolism (p = 0.014) and extended length of stay more than 3 days (p = 0.006) compared to the cohort aged 65–79. Following adjustment on multivariate analyses, 80–89 years old patients no longer had an increased likelihood of pulmonary embolism or extended length of stay compared to the 65–79 age group. Octogenarians were not found to have higher rates of 30-day readmissions (p = 0.782), mortality (p = 0.507), reoperation (p = 0.785), pneumonia (p = 0.417), urinary tract infection (p = 0.739), or sepsis (p = 0.464) compared to the cohort aged 65–79 following RTSA. Conclusion Age greater than 80 should not be used independently as a factor for evaluating whether a geriatric patient is a proper candidate for RTSA.

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