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

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.

scholarly journals The effect of operative time on early postoperative complications in total shoulder arthroplasty: An analysis of the ACS-NSQIP database

2019 ◽  
pp. 175857321987657
Author(s):  
Jacob M Wilson ◽  
Russell E Holzgrefe ◽  
Christopher A Staley ◽  
Spero Karas ◽  
Michael B Gottschalk ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Shoulder Arthroplasty ◽  
Operative Time ◽  
Glenohumeral Joint ◽  
Total Shoulder Arthroplasty ◽  
Provider Education ◽  
Level Of Evidence ◽  
Acs Nsqip ◽  
Increased Risk ◽  
Acs Nsqip Database

Background Total shoulder arthroplasty has been demonstrated to be an effective treatment for arthritis of the glenohumeral joint. Prior studies have identified longer operative times as a risk factor for complications after numerous types of procedures. We hypothesized that increased operative time, in 20-min intervals, would be associated with complications following total shoulder arthroplasty. Methods Patients undergoing total shoulder arthroplasty from 2006 to 2015 were identified from the ACS-NSQIP database. Patient demographic information, perioperative parameters, and 30-day outcomes were retrieved. Pearson's Chi-square test and multivariate Poisson regression with robust error variance were used to analyze the relationship of operative time and outcomes. Results A total of 10,082 patients were included. Multivariate analysis revealed that for each increase in 20 min of operative time, there were significantly increased rates of any complication (relative risk (RR) 1.24, 95% confidence interval (CI) 1.19–1.26), anemia requiring transfusion (RR 1.33, 95%CI 1.26–1.4), peripheral nerve injury (RR 1.88, 95%CI 1.53–2.31), and urinary tract infection (RR 1.24, 95%CI 1.09–1.41). Discussion This study indicates that increasing operative time confers increased risk for postoperative complications following total shoulder arthroplasty. We anticipate the results of this manuscript will be used for provider education, policy decision-making, and potentially to derive algorithms that can improve safety and efficiency in total shoulder arthroplasty. Level of evidence III.

Does resident involvement have an impact on postoperative complications after total shoulder arthroplasty? An analysis of 1382 cases

2015 ◽  
Vol 24 (10) ◽  
pp. 1567-1573 ◽  
Author(s):  
Gregory L. Cvetanovich ◽  
William W. Schairer ◽  
Bryan D. Haughom ◽  
Gregory P. Nicholson ◽  
Anthony A. Romeo
Keyword(s):  
Postoperative Complications ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Resident Involvement

Neuraxial anaesthesia is associated with improved outcomes and reduced postoperative complications in patients undergoing aseptic revision total hip arthroplasty

2020 ◽  
pp. 112070002097574
Author(s):  
Chapman Wei ◽  
Alex Gu ◽  
Arun Muthiah ◽  
Safa C Fassihi ◽  
Peter K Sculco ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
General Anaesthesia ◽  
Hip Arthroplasty ◽  
Postoperative Outcomes ◽  
Complication Rates ◽  
Total Hip ◽  
Neuraxial Anaesthesia ◽  
Extended Length

Background: As the incidence of primary total hip arthroplasty (THA) continues to increase, revision THA (rTHA) is becoming an increasingly common procedure. rTHA is widely regarded as a more challenging procedure, with higher complication rates and increased medical, social and economic burdens when compared to its primary counterpart. Given the complexity of rTHA and the projected increase in incidence of these procedures, patient optimisation is becoming of interest to improve outcomes. Anaesthetic choice has been extensively studied in primary THA as a modifiable risk factor for postoperative outcomes, showing favourable results for neuraxial anaesthesia compared to general anaesthesia. The impact of anaesthetic choice in rTHA has not been studied previously. Methods: A retrospective study was performed using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent rTHA between 2014 and 2017 were divided into 3 anaesthesia cohorts: general anaesthesia, neuraxial anaesthesia, and combined general-regional (neuraxial and/or peripheral nerve block) anaesthesia. Univariate and multivariate analyses were used to analyse patient characteristics and 30-day postoperative outcomes. Bonferroni correction was applied for post-hoc analysis. Results: In total, 5759 patients were identified. Of these, 3551 (61.7%) patients underwent general anaesthesia, 1513 (26.3%) patients underwent neuraxial anaesthesia, and 695 (12.1%) patients underwent combined general-regional anaesthesia. On multivariate analysis, neuraxial anaesthesia was associated with decreased odds for any-one complication (OR 0.635; p  < 0.001), perioperative blood transfusion (OR 0.641; p  < 0.001), and extended length of stay (OR 0.005; p = 0.005) compared to general anaesthesia. Conclusions: Relative to those receiving general anaesthesia, patients undergoing neuraxial anaesthesia are at decreased risk for postoperative complications, perioperative blood transfusions, and extended length of stay. Prospective controlled trials should be conducted to verify these findings.

scholarly journals Revision Total Shoulder Arthroplasty is Associated with Increased Thirty-Day Postoperative Complications and Wound Infections Relative to Primary Total Shoulder Arthroplasty

2017 ◽  
Vol 14 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Venkat Boddapati ◽  
Michael C. Fu ◽  
William W. Schairer ◽  
Lawrence V. Gulotta ◽  
David M. Dines ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Wound Infections

Acquisition of Methicillin-Resistant Staphylococcus aureus in a Large Intensive Care Unit

2003 ◽  
Vol 24 (5) ◽  
pp. 322-326 ◽  
Author(s):  
Caroline Marshall ◽  
Glenys Harrington ◽  
Rory Wolfe ◽  
Christopher K. Fairley ◽  
Steve Wesselingh ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Length Of Stay ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Multivariate Analyses ◽  
University Hospital ◽  
Trauma Patients ◽  
Increased Risk ◽  
Risk Patients ◽  
Mrsa Colonization ◽  
Previous Admission

AbstractObjectives:To determine the prevalence of MRSA colonization on admission to the ICU and the incidence of MRSA colonization in the ICU.Design:Prospective cohort study.Setting:University hospital.Participants:Patients admitted to the ICU in 2000-2001.Methods:Patients were screened for MRSA with nose, throat, groin, and axilla swabs on admission and discharge. MRSA acquisition was defined as a negative admission screen and a positive discharge screen. Risk factors analyzed included previous wards/current unit, gender, age, and length of stay prior to and in the ICU. Univariate and multivariate analyses were performed using logistic regression.Results:Of screened patients, 6.8% were MRSA colonized on admission to the ICU. Some patients (11.4%) became newly colonized during their stay in the ICU. Factors that remained significant in the multivariate analysis of MRSA colonization on admission were previous admission to various wards and length of stay prior to ICU admission of more than 3 days. In the multivariate analysis of MRSA acquisition in the ICU, being a trauma patient and length of stay in the ICU greater than 2 days remained significant. Thirty-six percent of patients had both admission and discharge swabs taken. This percentage increased in the presence of a supervisory nurse.Conclusion:Significant acquisition of MRSA occurs in the ICU of our hospital, with trauma patients at increased risk. Patients who had been on the cardiothoracic ward prior to the ICU had a lower risk of MRSA colonization on admission. Presence of a supervisory nurse improved compliance with screening.

Construct validation of machine learning in the prediction of short-term postoperative complications following total shoulder arthroplasty

2019 ◽  
Vol 28 (12) ◽  
pp. e410-e421 ◽  
Author(s):  
Anirudh K. Gowd ◽  
Avinesh Agarwalla ◽  
Nirav H. Amin ◽  
Anthony A. Romeo ◽  
Gregory P. Nicholson ◽  
...  
Keyword(s):  
Machine Learning ◽  
Postoperative Complications ◽  
Shoulder Arthroplasty ◽  
Construct Validation ◽  
Total Shoulder Arthroplasty ◽  
Short Term

Influence of Hypertension and Diabetes on Postoperative Outcomes In Cancer Patients Undergoing Moderate/High Risk Surgical Procedures

2021 ◽  
Author(s):  
Lafayete William Ferreira Ramos ◽  
Beatriz Nery Nascimento ◽  
Gabriel Rossi Silva ◽  
Marcos Vinícius Ferreira Ramos ◽  
Barbara Cristina Ferreira Ramos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Cancer Patients ◽  
Multiple Logistic Regression Analysis ◽  
Diabetic Group ◽  
Postoperative Outcomes ◽  
Morbidity And Mortality ◽  
Systemic Hypertension ◽  
Surgical Time ◽  
Increased Risk

Abstract Background: Systemic hypertension (HTN) and diabetes mellitus (DM) are believed to be risk factors for adverse postoperative outcomes in patients undergoing surgical interventions, but evidence is lacking. This retrospective study evaluated the effects of HTN and DM, alone or in combination, on postoperative outcomes of elective noncardiac surgery in cancer patients. Methods: Patients (n = 844) with malignancies, who underwent elective surgery at a tertiary hospital, were categorised into healthy (group A, n = 339), hypertensive (group B, n = 357), diabetic (group C, n = 21), and hypertensive and diabetic (group D, n = 127) groups. Preoperatively, all patients had systolic blood pressure ≤ 160 mmHg and plasma glucose level ≤ 140 mg/dl. Postoperative in-hospital morbidity and mortality were compared among groups. Results: Postoperative complications occurred in 22 (6.5%), 21 (5.9%), 2 (9.5%), and 11 (8.7%) patients in groups A, B, C, and D, respectively (p = 0.712). HTN (p = 0.538), DM (p = 0.990), and HTN+DM (p = 0.135) did not impact the occurrence of adverse events. Patients with higher surgical risk (ASA III or IV) and those with longer surgical time had higher morbidity and mortality (p = 0.001, p < 0.001, respectively). In multiple logistic regression analysis, ASA status and surgical time were independent risk factors for postoperative complications (both p < 0.001). Conclusion: Cancer patients with preoperative comorbidities, such as HTN and DM, alone or in combination, regardless of other characteristics, do not have an increased risk of adverse postoperative outcomes.Trial registration: Retrospectively registered.

scholarly journals Previous History of Breast Cancer Increases Rates of Pulmonary Embolism and Costs after Total Knee Arthroplasty: An Evaluation of 185,114 Matched Patients

2018 ◽  
Vol 32 (04) ◽  
pp. 337-343 ◽  
Author(s):  
Samuel Rosas ◽  
T. Luo ◽  
Alexander Jinnah ◽  
Alejandro Marquez-Lara ◽  
Martin Roche ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Pulmonary Embolism ◽  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Previous History ◽  
Increased Risk ◽  
Comorbidity Burden ◽  
History Of ◽  
Total Knee

AbstractRisk factors for adverse events after total knee arthroplasty (TKA) relating to malignancy have not been well studied. Thus, the purpose of this study was to conduct a retrospective case–control outcome and cost analysis after TKA in this population. Patients with a history of breast cancer (BrCa) were identified based on the International Classification of Disease 9th revision codes. An age- and sex-matched cohort was also identified of patients without a history of BrCa. Complications, length of stay, comorbidity burden, and reimbursements were tracked at 90 days. Each cohort comprised 92,557 patients. Length of stay was similar between cohorts (p = 0.627). Comorbidity status and incidence of pulmonary embolism (PE), lower extremity ultrasound, and chest computed tomography (CT) use were higher in patients with a history of BrCa (p < 0.05 for all). Control patients had a lower incidence of acute myocardial infarction (0.14 vs. 0.21%; p < 0.001). Surgical complications were similar. The 90-day reimbursements were greater in patients with a history of BrCa (US$13,990 vs. US$13,033 for controls; p = 0.021). Surgeons should be aware of the increased risk of PE after TKA in patients with a history of BrCa as well as increased 90-day costs, which warrant great attention.

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