BMI as a Risk Factor for Early Dislocation of Total Shoulder Arthroplasty

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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Preoperative Opioid Prescription is an Independent Risk Factor for Complication and Increased Healthcare Utilization Following Total Shoulder Arthroplasty

OrthoMedia ◽

10.1302/3114-210322 ◽

2021 ◽

Keyword(s):

Risk Factor ◽

Healthcare Utilization ◽

Shoulder Arthroplasty ◽

Independent Risk Factor ◽

Total Shoulder Arthroplasty ◽

Opioid Prescription

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Comparison of 90-Day Perioperative Outcomes in Shoulder Arthroplasty Between the Elderly and Nonelderly Patients

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459318803843 ◽

2018 ◽

Vol 9 ◽

pp. 215145931880384

Author(s):

Paul D. Crook ◽

William C. Foster ◽

Stephen L. Kates ◽

Jonathan R. Korpon ◽

Gustavo A. Ortega ◽

...

Keyword(s):

Risk Factor ◽

Elderly Patients ◽

Complication Rate ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Skilled Nursing Facility ◽

The Elderly ◽

Nursing Facility ◽

Skilled Nursing ◽

Discharge Disposition

Introduction: As life expectancy increases, the incidence of shoulder arthroplasty continues to increase as well. There are few shoulder arthroplasty studies investigating perioperative complication, readmission, and mortality. Furthermore, with bundled payments on the horizon, the cost of shoulder arthroplasty has become a significant issue. Clarifying risk factors for the need for postdischarge acute care will be critical information due to the high cost of such care. The goal of this study was to compare discharge disposition, length of stay (LOS), perioperative complications, readmission, and mortality in elderly and nonelderly cohorts to determine whether age is a risk factor for shoulder arthroplasty. Materials and Methods: We retrospectively compared 89 elderly patients (80 years or older) and 86 nonelderly patients (79 years or younger) who underwent hemiarthroplasty, total shoulder arthroplasty, reverse total shoulder arthroplasty, or revision shoulder arthroplasty from 2007 to 2015. Baseline characteristics were compared between the 2 cohorts. We then compared discharge disposition, LOS, 90-day complication rate, readmission, and mortality between the 2 cohorts. Results: Average length of hospitalization and percentage of patients with greater than 2 days of hospitalization were significantly higher in the elderly cohorts. Forty-four percent of the elderly cohorts were discharged to a skilled nursing facility compared to 6% in the nonelderly cohorts ( P < .0001). There were no significant differences found in 90-day major complication rate, readmission, or mortality. Discussion: Shoulder arthroplasty is a valuable surgery for various indications in the elderly population. However, the likelihood of a patient to need a prolonged hospitalization or skilled nursing facility care after surgery are important questions that need to be answered. Our study shows that age over 80 years is a risk factor for prolonged hospitalization and need for skilled nursing facility care after shoulder arthroplasty. Conclusion: We conclude that elderly patients who undergo shoulder arthroplasty are significantly more likely to have extended hospitalizations and to be discharged to skilled nursing facilities compared to nonelderly patients.

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Does Preservation of Coracoacromial Ligament Reduce the Acromial Stress Pathology Following Reverse Total Shoulder Arthroplasty?

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/24715492211022171 ◽

2021 ◽

Vol 5 ◽

pp. 247154922110221

Author(s):

Chang Hee Baek, MD ◽

Jung Gon Kim, MD ◽

Dong Hyeon Lee, MD ◽

Gyu Rim Baek

Keyword(s):

Risk Factor ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Clinical Score ◽

Reverse Total Shoulder Arthroplasty ◽

Occult Fracture ◽

Coracoacromial Ligament ◽

Group 2 ◽

Reverse Total Shoulder ◽

Group 1

Introduction Acromial pathologies (AP), such as acromial stress reaction (ASR), acromial stress occult fracture (ASOF), and acromial stress fracture (ASF), are known as complications that deteriorate the clinical score and patient satisfaction after reverse total shoulder arthroplasty (RSA). Several factors that increase stress on the acromion have been reported as risk factors for AP, but this is also unclear. Thecoracoacromial ligament (CAL) is a structure that distributes the stress loading on such an acromion, although its importance has been mentioned, there is a lack of research. Therefore, we investigated the incidence of AP according to the preservation of the CAL and whether it is a risk factor. Methods The study was retrospectively conducted on patients who underwent RSA from 2016 and 2018. Patients with CAL transection was classified into group 1 and CAL preservation was classified into group 2. ASR and ASOF were identified through symptoms and ultrasound, and ASF identified through simple radiograph or computed tomography. The incidence of AP in each group was checked and compared. Results Of the total of 265 patients. Among 197 cases of group 1, 21 cases of ASR(10.7%), 28 cases of ASOF (14.2%),10 cases of ASF (5.1%), and 59 cases of total AP (29.4%). Among 68 cases in group 2, 2 cases (2.9%) of ASR, 6 cases of ASOF(8.8%), 1 case of ASF (1.5%), and 9 cases of total AP (13.2%). It was confirmed that ASR and ASOP were significantly decreased in the group preserving CAL. (P = .008) Conclusion In the case of preservation of CAL during surgery, it was confirmed that the incidence of ASR, ASOF was reduced. Therefore, preservation of CAL can be regarded as a modifiable risk factor that can reduce the risk of AP by distributing the stress applied to acromion after RSA surgery.

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Shoulder Arthroplasty for Posttraumatic Arthritis Is Associated With Increased Transfusions and Longer Operative Times

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/2471549219882133 ◽

2019 ◽

Vol 3 ◽

pp. 247154921988213

Author(s):

Tyler A Luthringer ◽

Benjamin S Kester ◽

Oluwadamilola Kolade ◽

Mandeep S Virk ◽

Michael J Alaia ◽

...

Keyword(s):

Risk Factor ◽

Shoulder Arthroplasty ◽

Independent Risk Factor ◽

Hospital Admissions ◽

Total Shoulder Arthroplasty ◽

Posttraumatic Arthritis ◽

Improvement Program ◽

Primary Osteoarthritis ◽

Poor Outcomes ◽

Reverse Total Shoulder

Introduction: Posttraumatic arthritis (PTA) is a common sequela of proximal humerus fractures that is commonly managed with anatomic or reverse total shoulder arthroplasty (TSA). TSA for PTA is more challenging than that performed for primary osteoarthritis and frequently leads to worse patient outcomes. CPT uniformly classifies all cases of primary TSA, irrespective of procedural complexity and resource utilization. This study analyzes intraoperative differences and 30-day outcomes for anatomic and reverse TSA performed in the posttraumatic shoulder. Methods: Patients undergoing TSA from 2008 to 2015 were selected from the National Surgical Quality Improvement Program database and stratified according to concurrent procedures and administrative codes indicating posttraumatic diagnoses. Perioperative parameters and 30-day complications were recorded; multivariate analyses were performed to determine whether PTA was a risk factor for poor outcomes. Results: A total of 8508 primary and 243 posttraumatic TSAs were identified. Posttraumatic TSA patients were slightly younger ( P = .003), more likely to be female ( P < .001), smokers ( P = .029), and diabetic ( P = .003). Diagnosis of PTA was an independent risk factor for prolonged operative times ≥160 minutes (≥1 standard deviation above the mean, P = .003; odds ratio [OR]: 1.718; 95% confidence interval [CI]: 1.204–2.449) and increased bleeding requiring transfusion ( P < .001; OR: 2.719; 95% CI: 1.607–4.600). Although posttraumatic TSA had a tendency for longer hospital admissions, 30-day readmissions were not significantly different between cohorts. Conclusions: Compared with primary osteoarthritis, a preoperative diagnosis of PTA is an independent risk factor for prolonged operative times and postoperative transfusion in anatomic or reverse TSA patients; such patients may be less than optimal candidates for same-day discharges or outpatient shoulder arthroplasty.

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