Ninety-Day Readmission Following Shoulder Arthroplasty

Introduction Hospital readmissions after elective shoulder arthroplasty represent a costly burden to the health-care system due to the rising demand for this procedure. Nevertheless, the reasons for readmissions remain inconclusive. Therefore, the main purposes of the current investigation were to determine (1) the readmission rates within 90 days after shoulder arthroplasty, (2) the reasons behind those readmissions, and (3) the characteristics of readmitted patients. Methods A retrospective review was performed on 184 patients who underwent total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA) performed by a single surgeon at a single institution between 2010 and 2016. The readmissions that occurred within 90 days after surgery and their reasons were noted. Patient characteristics were compared between readmitted and non-readmitted patients. Results Overall, 7.1% of patients were readmitted within 90 days after shoulder arthroplasty. However, patients with a previous surgery on the same shoulder of the TSA or RSA had a higher rate (13.5%) than patients without a previous surgery (5.4%). Readmission rates for TSA and RSA were virtually identical. Most readmissions were due to surgical (69.2%) rather than medical complications (30.8%). The most common reasons for readmission were surgical-site infection and deep vein thrombosis. There were no statistically significant differences between the baseline patient characteristics of readmitted and non-readmitted patients. However, the proportion of males (69.2%) was more than twice the one of females (30.8%) among readmitted patients. Conclusion The readmission rate within 90 days after surgery was relatively low among patients who underwent either a TSA or RSA at our institution. Surgically related causes were largely responsible for readmissions.

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Quality of surgical care and readmission in elderly glioblastoma patients

Neuro-Oncology Practice ◽

10.1093/nop/npu008 ◽

2014 ◽

Vol 1 (2) ◽

pp. 33-39 ◽

Cited By ~ 3

Author(s):

Miriam Nuño ◽

Diana Ly ◽

Debraj Mukherjee ◽

Alicia Ortega ◽

Keith L. Black ◽

...

Keyword(s):

Quality Of Care ◽

Surgical Care ◽

Patient Characteristics ◽

Readmission Rates ◽

Vein Thrombosis ◽

Complex Interactions ◽

Hospital Readmission Rates ◽

Medicare Database ◽

Deep Vein

Abstract Background Thirty-day readmissions post medical or surgical discharge have been analyzed extensively. Studies have shown that complex interactions of multiple factors are responsible for these hospitalizations. Methods A retrospective analysis was conducted using the Surveillance, Epidemiology and End Results (SEER) Medicare database of newly diagnosed elderly glioblastoma multiforme (GBM) patients who underwent surgical resection between 1991 and 2007. Hospitals were classified into high- or low-readmission rate cohorts using a risk-adjusted methodology. Bivariate comparisons of outcomes were conducted. Multivariate analysis evaluated differences in quality of care according to hospital readmission rates. Results A total of 1,273 patients underwent surgery in 338 hospitals; 523 patients were treated in 228 high-readmission hospitals and 750 in 110 low-readmission hospitals. Patient characteristics for high-versus low-readmission hospitals were compared. In a confounder-adjusted model, patients treated in high- versus low-readmission hospitals had similar outcomes. The hazard of mortality for patients treated at high- compared to low-readmission hospitals was 1.06 (95% CI, 0.095%–1.19%). While overall complications were comparable between high- and low-readmission hospitals (16.3% vs 14.3%; P = .33), more postoperative pulmonary embolism/deep vein thrombosis complications were documented in patients treated at high-readmission hospitals (7.5% vs 4.1%; P = .01). Adverse events and levels of resection achieved during surgery were comparable at high- and low-readmission hospitals. Conclusions For patients undergoing GBM resection, quality of care provided by hospitals with the highest adjusted readmission rates was similar to the care delivered by hospitals with the lowest rates. These findings provide evidence against the preconceived notion that 30-day readmissions can be used as a metric for quality of surgical and postsurgical care.

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Patient Outcomes After Revision of Anatomic Total Shoulder Arthroplasty to Reverse Shoulder Arthroplasty for Rotator Cuff Failure or Component Loosening

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/jaaos-d-17-00350 ◽

2019 ◽

Vol 27 (4) ◽

pp. e193-e198 ◽

Cited By ~ 12

Author(s):

Edward Shields ◽

J. Michael Wiater

Keyword(s):

Rotator Cuff ◽

Patient Outcomes ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Component Loosening

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Complication rate and implant survival for reverse shoulder arthroplasty versus total shoulder arthroplasty: results during the initial 2 years

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2015.10.012 ◽

2016 ◽

Vol 25 (6) ◽

pp. 927-935 ◽

Cited By ~ 48

Author(s):

Diego Villacis ◽

Lakshmanan Sivasundaram ◽

William C. Pannell ◽

Nathanael Heckmann ◽

Reza Omid ◽

...

Keyword(s):

Complication Rate ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Implant Survival

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Improving Nutritional Status of Malnourished Bedridden Patient Diagnosed with Deep Vein Thrombosis and Pulmonary Embolism: A Case Study Approach

General medicine and Clinical Practice ◽

10.31579/2639-4162/001 ◽

2018 ◽

Vol 1 (1) ◽

pp. 01-04

Author(s):

Adikari AMNT

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Nutritional Status ◽

Nutritional Management ◽

Body Protein ◽

Study Approach ◽

Vein Thrombosis ◽

The One ◽

Deep Vein ◽

Bedridden Patient

Malnutrition is common among hospitalized bed ridden patients. Nutritional management of hospitalized patients is a necessity in order to improve their nutritional status and disease conditions. The objectives of nutritional management of malnourished bedridden patient diagnosed with deep vein thrombosis and pulmonary embolism were to improve nutritional status of the patient through gradual provision of calorie and protein intake, to improve body protein status and control muscle wasting. Nutritional status was assessed by anthropometric, biochemical, clinical and dietary information. SGA was used to assess the malnutrition status of the patient. Since the patient was severely malnourished, she was fed with NG feeds followed by PEG feeds by gradually increasing calorie and protein up to the target level mainly through nutritional supplements for the one and half months of hospital stay. Patient’s serum protein, albumin levels and muscle mass were improved. According to the SGA, the patient was at normal/ well-nourished condition after nutrition management. Dietary management incorporating nutrition supplements indicated improvement of nutritional status of severely malnourished bedridden patient.

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Glenoid bone grafting in primary anatomic total shoulder arthroplasty: a systematic review

Shoulder & Elbow ◽

10.1177/1758573220917653 ◽

2020 ◽

pp. 175857322091765

Author(s):

Betty Zhang ◽

Gavinn Niroopan ◽

Chetan Gohal ◽

Bashar Alolabi ◽

Timothy Leroux ◽

...

Keyword(s):

Bone Loss ◽

Shoulder Arthroplasty ◽

Bone Grafting ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Level Of Evidence ◽

Total Shoulder Arthroplasties ◽

Component Loosening ◽

Shoulder Arthroplasties

Background Primary anatomic total shoulder arthroplasty can be challenging in patients with complex glenoid wear patterns and bone loss. Severe retroversion (>15°) or significant bone loss may require bone grafting. This review summarizes the rate of revision and long-term outcomes of anatomic total shoulder arthroplasty with bone graft. Methods A systematic search of MEDLINE, Embase, PubMed, and CENTRAL databases was conducted from the date of inception to 23 October 2018. Two reviewers independently screened articles for eligibility and extracted data for analysis. The primary outcome was rate of revision. The secondary outcomes were rate of component loosening, functional outcome, and range of motion. Results Of the 1056 articles identified in the search, 26 underwent full-text screening and 7 articles were included in the analysis. All procedures were one-stage anatomic total shoulder arthroplasties. The rate of revision was 5.4% with component loosening and infection listed as indications over a weighted mean follow-up period of 6.3 years. Complications occurred in 12.6% of patients. Conclusion Glenoid bone grafting in anatomic total shoulder arthroplasty results in comparable revision rates and improvement in pain compared to augmented glenoid components and reverse shoulder arthroplasty. Due to the low quality of evidence, further prospective studies should be conducted. Level of evidence IV

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Anatomic versus reverse shoulder arthroplasty: a mid-term follow-up comparison

Shoulder & Elbow ◽

10.1177/1758573220921150 ◽

2020 ◽

pp. 175857322092115

Author(s):

Bradley S Schoch ◽

Joseph J King ◽

Joseph Zuckerman ◽

Thomas W Wright ◽

Chris Roche ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Patient Reported Outcomes ◽

External Rotation ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reoperation Rate ◽

Patient Reported ◽

Total Shoulder Arthroplasties ◽

Shoulder Arthroplasties

Background Anatomic total shoulder arthroplasty improves pain and function with a reported reoperation rate of approximately 1% per year. With improved glenoid fixation, reverse shoulder arthroplasty implants may outperform anatomic total shoulder arthroplasty. We evaluate the functional outcomes and reoperation rate of anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty at a minimum eight-year follow-up or revision. Methods Between 2005 and 2010, 187 shoulders (137 anatomic total shoulder arthroplasty, 50 reverse shoulder arthroplasty) were retrospectively reviewed at a mean of 8.8 years. The mean age at surgery was 67 years. Females were more commonly treated with reverse shoulder arthroplasty. Both groups had similar body mass index and comorbidities. Outcome measures evaluated included abduction, forward elevation, external rotation, internal rotation, Simple Shoulder Test, Constant score, American Shoulder and Elbow Score, University of California Los Angeles Shoulder score, and Shoulder Pain and Disability Index. Results At follow-up, anatomic total shoulder arthroplasty demonstrated greater overhead range of motion and external rotation. All patient-reported outcomes remained similar between groups. Reverse shoulder arthroplasty patients were more likely to rate shoulders as much better or better after surgery (90% versus 67%, p = 0.004). Complications were observed in 24% of anatomic total shoulder arthroplasties and 8% of reverse shoulder arthroplasties (p = 0.02). Reoperation was more common in anatomic total shoulder arthroplasties (23% versus 4%, p = 0.003). Discussion At mid-to-long-term follow-up, reverse shoulder arthroplasties demonstrated significantly fewer complications and reoperations than anatomic total shoulder arthroplasties. Despite similar patient-reported outcomes, reverse shoulder arthroplasty patients were more likely to be satisfied with their shoulder.

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Causes of acromion and scapular spine fractures following reverse shoulder arthroplasty: a retrospective analysis and literature review

International Orthopaedics ◽

10.1007/s00264-020-04813-5 ◽

2020 ◽

Vol 44 (12) ◽

pp. 2673-2681

Author(s):

Richard W. Nyffeler ◽

Bartu Altioklar ◽

Philipp Bissig

Keyword(s):

Bone Quality ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Control Group ◽

Time Interval ◽

Spine Fractures ◽

Poor Bone Quality ◽

Significant Deterioration ◽

Scapular Spine

Abstract Purpose Fractures of the acromion and the scapular spine are serious complications after reverse total shoulder arthroplasty. They concern about 4 to 5% of the patients and always result in a significant deterioration of shoulder function. Different causes have been taken into consideration, particularly stress or fatigue fractures. The purpose of the present study was to analyse our own cases and to discuss the causes reported in the literature. Methods We reviewed our shoulder arthroplasty registry and the consultation reports of the last ten years. The charts and radiographs of all patients who had a post-operative fracture of the acromion or the scapular spine were carefully examined and the results were compared with those of an age- and gender-matched control group. Results Twelve patients with an average age of 79 years sustained a fracture of the acromion (n = 6) or the scapular spine (n = 6). The time interval between the operation and the fracture averaged 26 months and ranged from three weeks to 70 months. Eight patients (67%) had a trauma. Seven of them reported a fall on the corresponding shoulder and one a heavy blow on the acromion. The four non-traumatic fractures were attributed to poor bone quality. All 12 patients had immediate pain and difficulty to actively elevate the affected arm. The time interval between the fracture and its diagnosis averaged ten weeks (0 to 10 months). At final follow-up, all patients could reach their face and refused further surgery. Two patients rated their result as good, six as acceptable and four as poor. Conclusions Our study cannot support the hypothesis that most acromion and scapular spine fractures after RSA are the result of increased tension in the deltoid or stress fractures. In our series, the majority of the fractures were related to a fall. Implantation of a reverse prosthesis exposes the acromion and makes it more vulnerable to direct trauma. Non-traumatic fractures were associated with poor bone quality.

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