Perioperative Management in Reverse Total Shoulder Arthroplasty

Predictors of inpatient mortality following reverse shoulder arthroplasty

INTRODUCTION

The number of reverse shoulder arthroplasties (RSA) performed each year is growing rapidly, especially in elderly patients and with expanded indications including geriatric proximal humerus fractures. As the elderly population grows and the number of RSA's annually continues to rise, there will be a proportionate number of adverse events and mortality. However, the rate of early mortality has consistently shown to be less than 1%, so a large-scale analysis of possible risk factors for post-operative mortality is warranted.

METHODS

A retrospective multivariate analysis of 59,915 patients from the National Inpatient Sample database between 2016 and 2019 was performed. Patients who underwent RSA were identified based on ICD-10 code. Patients were divided into two groups, early mortality and no mortality. Early mortality was defined as those who died within the same admission. Patient demographics and medical comorbidities were evaluated. Hospital admission status was classified as elective or non-elective. Odds ratios for predictive variables were measured as a ratio of incidence between the early mortality and no mortality groups.

RESULTS

The overall incidence of inpatient mortality was 0.07%. The incidence of mortality for elective admissions was 0.04% and for non-elective admissions was 0.34%. On univariate analysis, age greater than 75 years (p < 0.001), octogenarians (p < 0.001), nonagenarians (p < 0.001), and non-elective admission (p < 0.001) were associated with early mortality following RSA. Upon multivariate analysis, age greater than 75 years old had 4 times the odds of early mortality following RSA (OR 4.20; 95%CI (1.67, 10.60); p < 0.001) while non-elective admission had about 5 times the odds (OR 5.38; 95%CI (2.75, 10.53); p < 0.001).

DISCUSSION

Age greater than 75 years old has 4-fold higher odds and non-elective admission has 5-fold higher odds of early mortality following RSA. Appropriate pre-operative counseling should be performed with elderly patients and those undergoing non-elective indications for RSA.

Preventing Infections in Reverse Shoulder Arthroplasty

PURPOSE OF REVIEW

Reverse shoulder arthroplasty (rTSA) is a commonly performed procedure to treat degenerative conditions of the shoulder. With its growing utilization, techniques to reliably diagnose and treat prosthetic joint infection (PJI) have become increasingly important. In this review we outline the current research and prevention methods of prosthetic joint infection in rTSA. This includes preoperative considerations, intraoperative, and postoperative treatment algorithms.

RECENT FINDINGS

There is currently no established standardized protocol for preoperative infection prevention or post operative management. However, recent studies have identified risk factors for infection, as well as successful prevention techniques that can be implemented to minimize infection risk. Although there is no standardized protocol currently utilized to diagnose and treat shoulder PJI, we outline a potential set of preventative measures and postoperative management strategies that clinicians can use to properly diagnose and treat patients with this difficult condition.

Perioperative Management in Shoulder Arthroplasty: A Review of Current Practice

Perioperative management for patients undergoing shoulder arthroplasty has evolved significantly over the years to reduce overt complications and improve patient outcomes. The groundwork for perioperative care encompasses initial patient selection and education strategies for achieving successful outcome. Multimodal pain management strategies have advanced patient care with the increased use of new regional/local anesthetics. In addition, complications resulting from blood loss and transfusions have been curtailed with the use of synthetic antifibrinolytic agents. It remains critical for shoulder arthroplasty surgeons to optimize patients during the perioperative period through various modalities to maximize functional progression, outcomes, and patient's satisfaction following shoulder arthroplasty.