Incidence and Risk Factors of In-hospital Prosthesis-Related Complications Following Total Shoulder Arthroplasty

Abstract BackgroundThe occurrence of prosthesis-related complications after total shoulder arthroplasty is devastating and costly. The purpose was to determine the incidence and risk of in-hospital prosthesis-related complications after total shoulder arthroplasty utilizing a large-scale sample database.MethodsA retrospective database analysis was performed based on Nationwide Inpatient Sample from 2010 to 2014. Patients who underwent total shoulder arthroplasty were included. Patient demographics, hospital characteristics, length of stay, economic indicators, in-hospital mortality, comorbidities, and peri-operative complications were evaluated.ResultsA total of 34,198 cases were capture from the Nationwide Inpatient Sample database. There were 343 cases of in-hospital prosthesis-related complications after total shoulder arthroplasty and the overall incidence was 1%, with a more than 2.5-fold decrease from 2010 to 2014. Dislocation was the most common category among prosthesis-related complications (0.1%). The occurrence of in-hospital prosthesis-related complications was associated with significantly more total charges and slightly longer length of stay while less usage of Medicare. Risk factors of prosthesis-related complications were identified including younger age (<64 years), female, the native American, hospital in the South, alcohol abuse, depression, uncomplicated diabetes, diabetes with chronic complications, fluid and electrolyte disorders, metastatic cancer, neurological disorders, and renal failure. Interestingly, advanced age (≥65 years) and proprietary hospital were found as protective factors. Furthermore, prosthesis-related complications were associated with aseptic necrosis, rheumatoid arthritis, rotator cuff tear arthropathy, Parkinson’s disease, prior shoulder arthroscopy, and blood transfusion.ConclusionsIt is of benefit to study risk factors of prosthesis-related complications following total shoulder arthroplasty to ensure the appropriate management and optimize consequences although a relatively low incidence was identified.

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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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765. Pyomyositis in the United States: Trends and Associations From the Healthcare Utilization Project Nationwide Inpatient Sample Database

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.833 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S340-S341

Author(s):

Rheanne K Maravelas ◽

Thomas Melgar ◽

Sapna Sadarangani ◽

Neiberg Lima ◽

Zachary Rich ◽

...

Keyword(s):

Diabetes Mellitus ◽

United States ◽

Risk Factors ◽

Healthcare Utilization ◽

Nationwide Inpatient Sample ◽

Myositis Ossificans ◽

Organ Transplant ◽

The United States ◽

Nationwide Inpatient Sample Database ◽

Duration Of Hospitalization

Abstract Background Pyomyositis is a spontaneous infection of skeletal muscle that can lead to abscess formation and sepsis. The purpose of our study was to better describe the characteristics, risk factors, and trends of primary pyomyositis in the United States. Methods This study is a retrospective review of data from the Healthcare Utilization Project Nationwide Inpatient Sample Database from 2002 to 2014. We systematically searched ICD-9 codes and included diagnoses of infective myositis and/or tropical pyomyositis and excluded progressive myositis ossificans and/or traumatic myositis ossificans. We compiled lists of codes for co-occurring infections, candidate risk factors, and microbiological data. Each group of related ICD-9 codes was combined into a single composite indicator. SAS studio was utilized for analysis. Results The database included a total of 100,790,900 discharges accounting for 482,872,274 weighted discharges with 13,011 pyomyositis cases accounting for 62,657 weighted cases. The patients with pyomyositis were significantly more likely to be younger, male, and have a longer duration of hospitalization. The proportion of discharges with pyomyositis has steadily risen more than 3-fold from 0.0054% to 0.0209%. Of the cases of pyomyositis, a minority had co-occurring deep tissue infections: 16.9% had osteomyelitis and 8.8% had septic arthritis. We found significantly higher rates of co-occurrence with HIV, diabetes mellitus, organ transplant, alcohol abuse, and chronic kidney disease compared with the general hospitalized population, suggesting these as relevant risk factors. When microorganisms were diagnosed, Staphylococus aureus was most common, followed by Streptococcus spp. Conclusion Our study identified a rapid increase in pyomyositis cases in the United States over our 12-year study period. Our results substantiate risk factors for pyomyositis related to immunosuppression and suggest that diabetes mellitus may be an important risk factor in the United States. Identifying causative organisms is helpful for empiric treatment. It is important that clinicians be aware of this emerging diagnosis relevant in both temperate and tropical areas of the globe. Disclosures All authors: No reported disclosures.

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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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Palliative Care in Ruptured Aortic Aneurysm in the United States: A Retrospective Analysis of Nationwide Inpatient Sample Database

Angiology ◽

10.1177/0003319720917239 ◽

2020 ◽

Vol 71 (7) ◽

pp. 633-640

Author(s):

Tomo Ando ◽

Oluwole Adegbala ◽

Takeshi Uemura ◽

Said Ashraf ◽

Emmanuel Akintoye ◽

...

Keyword(s):

Palliative Care ◽

Aortic Aneurysm ◽

Length Of Stay ◽

Nationwide Inpatient Sample ◽

The United States ◽

Hospitalization Cost ◽

Ruptured Aortic Aneurysm ◽

Nationwide Inpatient Sample Database ◽

The Cost ◽

Repair Group

We assessed the trend of palliative care (PC) referrals and its effect on hospitalization cost and length of stay (LOS) in ruptured aortic aneurysm (rAA). The Nationwide Inpatient Sample from 2005 to 2014 was used to identify admissions with age ≥50 and rAA. A total of 54 134 rAA admissions were identified and 5019 (9.3%) had PC referrals. During the study period, PC referral rate increased from 0.97% to 15.3% ( P trend < .0001). Length of stay (1.7 vs 2.8 days, adjusted mean ratio [aMR] = 0.62, 95% confidence interval [CI]: 0.58-0.66), and cost (US$7778 vs US$13 575, aMR = 0.57, 95% CI: 0.52-0.63) were significantly lower in rAA admissions that did not undergo interventions. In the percutaneous repair group, LOS was similar but the cost was higher (US$61 759 vs US$52 260, aMR = 1.18, 95% CI: 1.05-1.30), whereas in surgical repair group, LOS was shorter (4.6 vs 5.9 days, aMR = 0.77, 95% CI: 0.73-0.82) but the cost was higher (US$59 755 vs US$52 523, aMR = 1.14, 95% CI: 1.02-1.28). Palliative care could shorten LOS and save hospitalization cost in rAA admissions not a candidate for repair. Further studies are required to investigate the variable effects of PC on rAA.

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Effect of Weekend Compared to Weekday Stroke Admission on Thrombolytic Use, In-Hospital Mortality, Discharge Disposition, Hospital Charges, and Length of Stay in the Nationwide Inpatient Sample Database: 2002–2006

Neurosurgery ◽

10.1227/01.neu.0000386975.09818.55 ◽

2010 ◽

Vol 67 (2) ◽

pp. 537-537

Author(s):

Brian Lim Hoh ◽

Yueh-Yun Chi ◽

Michael F. Waters ◽

J. D. Mocco ◽

Frederick George Barker

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Nationwide Inpatient Sample ◽

Hospital Charges ◽

Discharge Disposition ◽

Nationwide Inpatient Sample Database

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Risk Factors for Neck Hematoma after Thyroid or Parathyroid Surgery: Ten-Year Analysis of the Nationwide Inpatient Sample Database

The Permanente Journal ◽

10.7812/tpp/14-085 ◽

2015 ◽

pp. 22-28 ◽

Cited By ~ 26

Author(s):

Ahmed Dehal

Keyword(s):

Risk Factors ◽

Nationwide Inpatient Sample ◽

Parathyroid Surgery ◽

Nationwide Inpatient Sample Database

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

Shoulder & Elbow ◽

10.1177/1758573218780517 ◽

2018 ◽

Vol 11 (5) ◽

pp. 332-343 ◽

Cited By ~ 1

Author(s):

Aakash Keswani ◽

Debbie Chi ◽

Andrew J Lovy ◽

Daniel A London ◽

Paul J Cagle ◽

...

Keyword(s):

Risk Factors ◽

Adverse Events ◽

Shoulder Arthroplasty ◽

Perioperative Complications ◽

Total Shoulder Arthroplasty ◽

Significant Risk ◽

Significant Risk Factor ◽

Perioperative Outcomes ◽

Unplanned Readmission ◽

Acs Nsqip Database

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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