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DeBernardis DA, Zhang T, Duong A, Fleckenstein CM, Almasri M, Hasan SS. Total shoulder arthroplasty in patients aged 80 years and older: a systematic review. J Shoulder Elbow Surg 2024; 33:425-434. [PMID: 37696486 DOI: 10.1016/j.jse.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Elderly patients and their surgeons may eschew shoulder arthroplasty due to concerns over patient safety and longevity. The purpose of this study was to review the current literature evaluating the clinical and radiographic outcomes of shoulder arthroplasty performed in patients 80 years and older. METHODS A literature search of the Embase, PubMed, Medline, and Cochrane databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies evaluating the outcomes of primary and revision anatomic (aTSA) and reverse (RSA) total shoulder arthroplasty in patients 80 years and older were included for analysis. RESULTS A total of 15 studies evaluating 1685 primary aTSAs, 1170 primary RSAs, 69 RSAs performed for fracture, and 45 revision RSAs were included for review. The postoperative active forward flexion and external rotation ranged from 138° to 150° and 45° to 48° after aTSA and from 83° to 139° and 16° to 47° after RSA, respectively. Postoperative visual analog scale pain scores ranged from 0 to 1.8 after aTSA and from 0 to 1.4 after RSA. Ninety-day mortality ranged from 0% to 3%, and perioperative complications ranged from 0% to 32%. Late complications ranged from 5.6% to 24% for aTSA patients and 3.5% to 29% for patients undergoing RSA for all indications. Common complications included glenoid loosening (0%-18%) and rotator cuff tear (5.6%-10%) after aTSA and scapular notching (0%-40%) and scapular fracture (4%-9.4%) after RSA. Reoperation rates ranged from 0% to 6% after aTSA and from 0% to 13% after RSA. CONCLUSIONS aTSA and RSA in this population are safe and effective, demonstrating low rates of perioperative mortality and reoperation, durability that exceeds patient longevity, satisfactory postoperative range of motion, and excellent pain relief. Late complication rates appear to be similar for aTSA and RSA.
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Affiliation(s)
- Dennis A DeBernardis
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA; OrthoCincy, Edgewood, KY, USA
| | - Ting Zhang
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA
| | - Andrew Duong
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Cassie M Fleckenstein
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA
| | - Mahmoud Almasri
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA
| | - Samer S Hasan
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA.
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Stauffer TP, Goltz DE, Wickman JR, Levin JM, Lassiter TE, Anakwenze OA, Klifto CS. Trends in outcomes following aseptic revision shoulder arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3025-3031. [PMID: 36964819 DOI: 10.1007/s00590-023-03524-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/09/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE As the incidence of anatomic and reverse total shoulder arthroplasty (TSA, RSA) increases, revision procedures will also increase with a corresponding need for counseling patients regarding outcomes. We hypothesized that different revision categories would have different complication profiles depending on both the indication as well as the nature of the prior hardware. METHODS A retrospective review of 1773 cases performed at a single tertiary health system utilized case postings and diagnoses to identify revision shoulder arthroplasty cases. Revisions were classified based on the prior hardware present, with basic demographics and other perioperative and postoperative outcomes recorded within the limits of available follow-up. RESULTS 166 surgical cases involving revision of prior shoulder arthroplasty metal hardware were identified with an average follow-up of 1.0 years. Immediate perioperative outcomes of revision cases were similar relative to the companion cohort of 1607 primary cases. 137 cases (83%) required no further revision surgery, while 19 cases (11%) underwent aseptic revision, and 10 cases (6%) were revised for periprosthetic infection. RSA hardware revised to another RSA had the highest repeat revision rate relative to the other revision categories (32% vs < 14%). CONCLUSIONS Revision of reverse shoulder arthroplasty to a repeat reverse has the highest rate of subsequent all-cause revision, and these repeat revisions often occurred for periprosthetic infection. Despite a relatively high long-term complication rate following revision shoulder arthroplasty, immediate perioperative outcomes remain similar to primary cases, providing some preliminary evidence for policymakers considering inclusion in future value-based care models. LEVEL OF EVIDENCE Level III Treatment Study.
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Affiliation(s)
- Taylor P Stauffer
- School of Medicine, Duke University Hospital, Duke University, 40 Duke Medicine Circle, Durham, NC, 27710, USA.
| | - Daniel E Goltz
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA
| | - John R Wickman
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA
| | - Jay M Levin
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA
| | - Tally E Lassiter
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA
| | - Oke A Anakwenze
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA
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Toutoungy M, Venishetty N, Mounasamy V, Khazzam M, Sambandam S. Reverse Shoulder Arthroplasty in Nonagenarians - NIS-based study of perioperative and postoperative complications. J Orthop 2023; 42:40-44. [PMID: 37483644 PMCID: PMC10362003 DOI: 10.1016/j.jor.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose Our aim is to investigate the length of stay (LOS), cost of care (COC) and postoperative complications associated with reverse shoulder arthroplasty (RSA) in nonagenarians (people aged 90-99 years old). Methods We used the National Inpatient Sample (NIS) database to identify 59,925 patients who underwent RSA between 2016 and 2019, including 555 nonagenarians. We investigated the incidences of various medical and orthopedic postoperative complications in nonagenarians compared to their younger counterparts, as well as compared nonagenarians undergoing elective and non-elective surgery. Results Nonagenarians were less likely admitted for elective surgery (69.9% in nonagenarians vs 92.8% in controls, p < 0.001) and were subject to longer LOS (3.5 days in nonagenarians vs 1.89 days in controls, p < 0.001) and greater COC ($91,794.69 US in nonagenarians vs $79,574.12 US in controls, p < 0.001). Nonagenarians had increased incidences of hospital mortality (0.72% in nonagenarians vs 0.06% in controls, p < 0.001), pneumonia (1.44% in nonagenarians vs 0.37% in controls, p < 0.001), blood loss anemia (22.34% in nonagenarians vs 10.12% in controls, p < 0.001), and ARF (6.85% in nonagenarians vs 2.18% in controls, p < 0.001). Nonagenarians undergoing elective RSA had fewer complications than those requiring non-elective RSA. Conclusion Nonagenarians undergoing RSA are subject to increased LOS, COC, and postoperative complications. Despite this, we feel that the associated complications can be deemed acceptable and that with adequate preparation, the benefits of a successful RSA may outweigh the associated complications in elderly patients. This is important to aid clinicians and patients in making informed decisions for patient care and resource allocation, as well as highlights room for improvement in costs and hospital stay, as well as sheds light on persistent health disparities in orthopedic surgery. Level of evidence IV.
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Affiliation(s)
- Michel Toutoungy
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Nikit Venishetty
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Dallas VAMC, Dallas, TX, USA
| | - Michael Khazzam
- University of Texas Southwestern Medical Center, Orthopaedic Surgery, Dallas, TX, USA
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Partan M, Frane N, Iturriaga C, Matai P, Bitterman A. Short-Term Outcomes of Primary Total Ankle Arthroplasty in Octogenarians: A National Database Analysis. Foot Ankle Spec 2022; 15:346-353. [PMID: 33000649 DOI: 10.1177/1938640020960546] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) is an increasingly popular option for end-stage ankle arthritis. Americans over the age of 80 years grew to 16.7 million in 2010, but there are scarce data assessing the outcomes of octogenarians undergoing TAA. This study evaluated (1) perioperative factors, (2) 30-day postoperative complications compared to a nonoctogenarian cohort, and (3) independent risk factors for adverse outcomes. METHODS A national database registry was queried for patients who had undergone primary TAA. This yielded 1113 patients, under (n = 1059) and over (n = 54) age 80 years. Demographics and perioperative data were compared using Fisher's exact, χ2, and independent-samples t tests. Logistic and Poisson regressions were used to calculate odds ratio (OR) of complications and independent risk factors. RESULTS The octogenarian cohort had longer in-hospital length of stay (1.9 vs 2.5 days, P < .0001). Octogenarians were not significantly more likely to develop any complication (OR = 1.32; 95% confidence interval = 0.29-6.04; P = .722), or increased number of complications (OR = 1.18; 95% CI = 0.27-5.18; P = .820). Octogenarians had significantly increased risk of being discharged to rehab/skilled nursing (OR = 6.60; 95% CI = 2.16-20.15; P < .001) instead of home. CONCLUSION Although the elderly population may carry inherent risk factors, octogenarians do not present an increased risk of short-term complications following TAA. LEVELS OF EVIDENCE Therapeutic, Level III: Retrospective cohort study.
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Affiliation(s)
- Matthew Partan
- Department of Orthopaedic Surgery, Northwell Health Plainview Hospital, Plainview, New York (MP, NF, CI, PM).,Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, New York (CI).,Department of Orthopaedic Surgery, Northwell Health Huntington Hospital, Huntington, New York (AB).,Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, New York (AB)
| | - Nicholas Frane
- Department of Orthopaedic Surgery, Northwell Health Plainview Hospital, Plainview, New York (MP, NF, CI, PM).,Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, New York (CI).,Department of Orthopaedic Surgery, Northwell Health Huntington Hospital, Huntington, New York (AB).,Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, New York (AB)
| | - Cesar Iturriaga
- Department of Orthopaedic Surgery, Northwell Health Plainview Hospital, Plainview, New York (MP, NF, CI, PM).,Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, New York (CI).,Department of Orthopaedic Surgery, Northwell Health Huntington Hospital, Huntington, New York (AB).,Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, New York (AB)
| | - Prashant Matai
- Department of Orthopaedic Surgery, Northwell Health Plainview Hospital, Plainview, New York (MP, NF, CI, PM).,Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, New York (CI).,Department of Orthopaedic Surgery, Northwell Health Huntington Hospital, Huntington, New York (AB).,Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, New York (AB)
| | - Adam Bitterman
- Department of Orthopaedic Surgery, Northwell Health Plainview Hospital, Plainview, New York (MP, NF, CI, PM).,Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, New York (CI).,Department of Orthopaedic Surgery, Northwell Health Huntington Hospital, Huntington, New York (AB).,Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, New York (AB)
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Carney JJ, Gerlach E, Plantz M, Swiatek PR, Marx J, Saltzman M, Marra G. Primary versus revision total shoulder arthroplasty: comparing relative value and reimbursement trends. Clin Shoulder Elb 2022; 25:42-48. [PMID: 35045596 PMCID: PMC8907504 DOI: 10.5397/cise.2021.00458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022] Open
Abstract
Background Total shoulder arthroplasty (TSA) has been demonstrated to be an effective treatment for multiple shoulder pathologies. The purpose of our study was to compare the relative value units (RVUs) per minute of surgical time for primary and revision TSA. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients that underwent primary TSA, one-component revision TSA, and two-component revision TSA between January 1, 2015 and December 31, 2017 using current procedure terminology codes. RVUs were divided by mean operative time for each procedure to determine the amount of revenue generated per minute. Rates were compared between the groups using a one-way analysis of variance with post-hoc Tukey test. Statistical significance was set at p<0.05. Results When dividing compensation by surgical time, we found that two-component revision generated more compensation per minute compared to primary TSA (0.284±0.114 vs. 0.239±0.278 RVU per minute or $10.25±$4.11 vs. $8.64±$10.05 per minute, respectively; p=0.001). Conclusions The relative value of revision TSA procedures is weighted to account for the increased technical challenges and time associated with these procedures. This study confirms that reimbursement is higher for revision TSA compared to primary TSA.
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Affiliation(s)
- John Joseph Carney
- Department of Orthopaedic Surgery, Northwestern University, Evanston, IL, USA
| | - Erik Gerlach
- Department of Orthopaedic Surgery, Northwestern University, Evanston, IL, USA
| | - Mark Plantz
- Department of Orthopaedic Surgery, Northwestern University, Evanston, IL, USA
| | | | - Jeremy Marx
- Department of Orthopaedic Surgery, Northwestern University, Evanston, IL, USA
| | - Matthew Saltzman
- Department of Orthopaedic Surgery, Northwestern University, Evanston, IL, USA
| | - Guido Marra
- Department of Orthopaedic Surgery, Northwestern University, Evanston, IL, USA
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Carney J, Gerlach E, Plantz MA, Cantrell C, Swiatek PR, Marx JS, Marra G. Short-Term Outcomes After Total Shoulder Arthroplasty in Octogenarians: A Matched Analysis. Cureus 2021; 13:e16441. [PMID: 34422472 PMCID: PMC8367019 DOI: 10.7759/cureus.16441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Studies have shown that the use of total shoulder arthroplasty is increasing every year in the United Stated at a rate higher than that of total hip or total knee arthroplasty. As the population of the United States continues to age, it is becoming more important for surgeons to understand the true impact of age on outcomes and complications following procedures such a total shoulder arthroplasty. The purpose of this study was to determine if octogenarians have poorer outcomes after total shoulder arthroplasty compared to a younger, matched control group. Methods Data was obtained through the American College of Surgeons National Surgical Quality Improvement Program database (ACS NSQIP). Patients who had undergone total shoulder arthroplasty were identified by Current Procedural Terminology code (23472). Indication for arthroplasty was determined by ICD9/10 code (osteoarthritis, fracture, other). Each octogenarian was matched 1:1 to a non-octogenarian based on sex, BMI, ASA class, medical comorbidities, functional status, and surgical indication for arthroplasty by propensity scoring. A subgroup analysis was performed to compare outcomes between only those patients who underwent TSA for osteoarthritis.Outcomes of interest were assessed between the two groups for statistical significance using a chi-squared test or fisher exact test for expected values of less than 5. Statistical significance was set at p<0.05. Results After matching, octogenarians were found to be at higher risk of readmission (4.7% vs. 3.3%, p=0.046), non-home discharge (27.1% vs. 9.4%, p<0.001), and overall surgical (4.4% vs. 2.5%, p=0.006) and medical complications (3.7% vs. 2.4%, p=0.039). In the setting of TSA for osteoarthritis only, however, octogenarians were only at higher risk for non-home discharge (22.4% vs. 7.5%, p<0.001). Conclusions Octogenarians are at higher risk of some complications following total shoulder arthroplasty but fewer than has been previously reported, particularly in the setting of arthroplasty for the treatment of arthritis.
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Affiliation(s)
- John Carney
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Erik Gerlach
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Mark A Plantz
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Colin Cantrell
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Peter R Swiatek
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Chicago, USA
| | - Jeremy S Marx
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Guido Marra
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
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Anatomic and reverse shoulder arthroplasty in patients 70 years of age and older: a comparison cohort at early to midterm follow-up. J Shoulder Elbow Surg 2021; 30:1336-1343. [PMID: 32920109 DOI: 10.1016/j.jse.2020.08.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) has gained popularity in elderly patients because of its limited reliance on rotator cuff function and high survivorship rates. However, although there are theoretical advantages of RSA over anatomic total shoulder arthroplasty (TSA) in elderly patients, there is little data to guide surgeons on implant selection in this population. METHODS Patients were identified from our prospectively collected shoulder arthroplasty registry. We included patients between the age of 50 and 89 years who underwent primary TSA for osteoarthritis with intact rotator cuff or primary RSA for cuff tear arthropathy. The minimum and mean clinical follow-up was 2 and 3.1±1.3 years, respectively. Four patient groups were formed for analysis: (1) TSA age 50-69 years (n=274), (2) TSA age 70-89 years (n=208), (3) RSA age 50-69 years (n=81), and (4) RSA age 70-89 years (n=104). We evaluated age group differences in pain, Constant score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, patient satisfaction, complications, and revisions. RESULTS All groups showed significant improvements from preoperative to final follow-up for all outcome measures (P < .001). Visual analog scale for pain average score decreased from 5.8 preoperatively to 1.1, with no significant differences between groups (TSA P = .180; RSA P = .103). Final ASES scores and improvement from preoperative ASES score between the age groups were not significantly different (TSA P = .520; RSA P = .065). There were no significant differences in outcomes between TSA in patients older than 70 years vs. patients younger than 70 years (all P > .05); however, older RSA patients reported better function during activities of daily living (P = .020) than their younger counterparts. Patients undergoing TSA had a lower revision rate of 3.9% compared with 8.1% in the RSA group (P = .043). CONCLUSIONS TSA and RSA are reliable procedures for patients older than 70 years, and have comparable results to their respective patient cohorts younger than 70 years. Although some surgeons anecdotally advocate for RSA in patients older than 70 years with primary osteoarthritis and an intact rotator cuff, we found no difference in outcomes for TSA based on our age cutoff. Given satisfactory results following TSA in patients 70 years of age and older, we do not routinely perform RSA for primary osteoarthritis with an intact rotator cuff solely based on age. Further studies and longer follow-up are needed to determine the optimal implant selection for elderly patients with primary osteoarthritis.
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Sodhi N, Anis HK, Vakharia RM, Acuña AJ, Gold PA, Garbarino LJ, Mahmood BM, Arnold NR, Ehiorobo JO, Grossman EL, Mont MA, Roche MW. What Are Risk Factors for Infection after Primary or Revision Total Joint Arthroplasty in Patients Older Than 80 Years? Clin Orthop Relat Res 2020; 478:1741-1751. [PMID: 32662957 PMCID: PMC7371091 DOI: 10.1097/corr.0000000000001389] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/09/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients older than 80 years of age form an increasing proportion of the patient population undergoing total joint arthroplasty (TJA). With increasing life expectancy and the success of TJA, orthopaedic surgeons are more likely to operate on patients older than 80 years than ever before. Given that most other studies focus on younger populations, only evaluate primary TJA, or limit patient populations to institutional or regional data, we felt a large-database, nationwide analysis of this demographic cohort was warranted, and we wished to consider both primary and revision TJA. QUESTIONS/PURPOSES In this study, we sought to investigate the risk factors for surgical site infections (SSIs) at 90 days and periprosthetic joint infections (PJIs) at 2 years after surgery in patients aged 80 years and older undergoing (1) primary and (2) revision lower extremity TJA. METHODS All patients aged 80 years or older who underwent primary or revision TJA between 2005 and 2014 were identified using the Medicare Analytical Files of the PearlDiver Supercomputer using ICD-9 codes. This database is unique in that it is one of the largest nationwide databases, and so it provides a large enough sample size of patients 80 years or older. Additionally, this database provides comprehensive and longitudinal patient data tracking, and a low error rate. Our final cohort consisted of 503,241 patients (TKA: n = 275,717; THA: n = 162,489; revision TKA: n = 28,779; revision THA: n = 36,256). Multivariate logistic regression models were constructed to evaluate the association of risk factors on the incidences of 90-day SSI and 2-year PJI. Variables such as sex, diabetes, BMI, and congestive heart failure, were included in the multivariate regression models. Several high-risk comorbidities as identified by the Charlson and Elixhauser comorbidity indices were selected to construct the models. We performed a Bonferroni-adjusted correction to account for the fact that multiple statistical comparisons were made, with a p value < 0.002 being considered statistically significant. RESULTS For primary TKA patients, an increased risk of 90-day SSIs was associated with male sex (OR 1.28 [95% CI 1.25 to 1.52]; p < 0.001), BMI greater than 25 k/m (p < 0.001), and other comorbidities. For primary THA patients, an increased risk of 90-day SSIs was associated with patients with obesity (BMI 30-39 kg/m; OR 1.91 [95% CI 1.60 to 2.26]; p < 0.001) and those with morbid obesity (BMI 40-70 kg/m; OR 2.58 [95% CI 1.95 to 3.36]; p < 0.001). For revision TKA patients, an increased risk of SSI was associated with iron-deficiency anemia (OR 1.82 [95% CI 1.37 to 2.28]; p < 0.001). For revision THA patients, electrolyte imbalance (OR 1.48 [95% CI 1.23 to 1.79]; p < 0.001) and iron-deficiency anemia (OR 1.63 [95% CI 1.35 to 1.99]; p < 0.001) were associated with an increased risk of 90-day SSI. Similar associations were noted for PJI in each cohort. CONCLUSIONS These findings show that in this population, male sex, obesity, hypertension, iron-deficiency anemia, among other high-risk comorbidities are associated with a higher risk of SSIs and PJIs. Based on these findings, orthopaedic surgeons should actively engage in comanagement strategies with internists and other specialists to address modifiable risk factors through practices such as weight management programs, blood pressure reduction, and electrolyte balancing. Furthermore, this data should encourage healthcare systems and policy makers to recognize that this patient demographic is at increased risks for PJI or SSI, and these risks must be considered when negotiating payment bundles. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Nipun Sodhi
- N. Sodhi, P. A. Gold, L. J. Garbarino, J. O. Ehiorobo, M. A. Mont, Lenox Hill Hospital, New York, NY, USA
- N. Sodhi, P. A. Gold, L. J. Garbarino, J. O. Ehiorobo, M. A. Mont, Long Island Jewish Medical Center, New York, NY, USA
| | - Hiba K Anis
- H. K. Anis, A. J. Acuña, B. M. Mahmood, N. Arnold, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rushabh M Vakharia
- R. M. Vakharia, M. W. Roche, Holy Cross Hospital, Fort Lauderdale, FL, USA
| | - Alexander J Acuña
- H. K. Anis, A. J. Acuña, B. M. Mahmood, N. Arnold, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Peter A Gold
- N. Sodhi, P. A. Gold, L. J. Garbarino, J. O. Ehiorobo, M. A. Mont, Lenox Hill Hospital, New York, NY, USA
- N. Sodhi, P. A. Gold, L. J. Garbarino, J. O. Ehiorobo, M. A. Mont, Long Island Jewish Medical Center, New York, NY, USA
| | - Luke J Garbarino
- N. Sodhi, P. A. Gold, L. J. Garbarino, J. O. Ehiorobo, M. A. Mont, Lenox Hill Hospital, New York, NY, USA
- N. Sodhi, P. A. Gold, L. J. Garbarino, J. O. Ehiorobo, M. A. Mont, Long Island Jewish Medical Center, New York, NY, USA
| | - Bilal M Mahmood
- H. K. Anis, A. J. Acuña, B. M. Mahmood, N. Arnold, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nicholas R Arnold
- H. K. Anis, A. J. Acuña, B. M. Mahmood, N. Arnold, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Joseph O Ehiorobo
- N. Sodhi, P. A. Gold, L. J. Garbarino, J. O. Ehiorobo, M. A. Mont, Lenox Hill Hospital, New York, NY, USA
- N. Sodhi, P. A. Gold, L. J. Garbarino, J. O. Ehiorobo, M. A. Mont, Long Island Jewish Medical Center, New York, NY, USA
| | - Eric L Grossman
- E. L. Grossman, Rothman Orthopaedic Institute, New York, NY, USA
| | - Michael A Mont
- N. Sodhi, P. A. Gold, L. J. Garbarino, J. O. Ehiorobo, M. A. Mont, Lenox Hill Hospital, New York, NY, USA
- N. Sodhi, P. A. Gold, L. J. Garbarino, J. O. Ehiorobo, M. A. Mont, Long Island Jewish Medical Center, New York, NY, USA
| | - Martin W Roche
- R. M. Vakharia, M. W. Roche, Holy Cross Hospital, Fort Lauderdale, FL, USA
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Hijazi A, Padela MT, Sayeed Z, Hammad A, Devole K, Frush T, Mostafa G, Yassir WK, Saleh KJ. Review article: Patient characteristics that act as risk factors for intraoperative complications in hip, knee, and shoulder arthroplasties. J Orthop 2019; 17:193-197. [PMID: 31879503 DOI: 10.1016/j.jor.2019.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/16/2019] [Indexed: 11/25/2022] Open
Abstract
The number of annual THA's, TKA's, and TSA's is set to increase significantly by the year 2030, making it imperative to understand the risks for negative outcomes in these procedures. While research has studied the patient risk factors for perioperative and postoperative complications, there has been relatively little research for intraoperative complications. After a thorough literature review, the most supported finding was that patients with a BMI >30 had significantly more intraoperative blood loss than those with a BMI <30. All other relationships between patient risk factors and intraoperative complications of interest were inadequately studied.
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Affiliation(s)
- Adel Hijazi
- John D. Dingell Veteran Affairs Medical Center, Detroit, MI, USA
| | - Muhammad Talha Padela
- John D. Dingell Veteran Affairs Medical Center, Detroit, MI, USA.,FAJR Scientific, Detroit, MI, USA.,Resident Research Partnership, Detroit, MI, USA.,Chicago Medical School, Department of Orthopaedic Surgery, Rosalind Franklin University, North Chicago, IL, USA.,Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Zain Sayeed
- FAJR Scientific, Detroit, MI, USA.,Resident Research Partnership, Detroit, MI, USA.,Chicago Medical School, Department of Orthopaedic Surgery, Rosalind Franklin University, North Chicago, IL, USA.,Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Aws Hammad
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Kamela Devole
- John D. Dingell Veteran Affairs Medical Center, Detroit, MI, USA.,FAJR Scientific, Detroit, MI, USA
| | - Todd Frush
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Gamal Mostafa
- John D. Dingell Veteran Affairs Medical Center, Detroit, MI, USA.,FAJR Scientific, Detroit, MI, USA
| | | | - Khaled J Saleh
- John D. Dingell Veteran Affairs Medical Center, Detroit, MI, USA.,FAJR Scientific, Detroit, MI, USA.,Michigan State University College of Medicine, Detroit, MI, USA.,Saleh Medical Innovations PLLC, Northville, MI, USA
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10
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Craig RS, Lane JCE, Carr AJ, Furniss D, Collins GS, Rees JL. Serious adverse events and lifetime risk of reoperation after elective shoulder replacement: population based cohort study using hospital episode statistics for England. BMJ 2019; 364:l298. [PMID: 30786996 PMCID: PMC6380386 DOI: 10.1136/bmj.l298] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To provide accurate risk estimates of serious adverse events after elective shoulder replacement surgery for arthritis, including age and sex specific estimates of the lifetime risk of revision surgery. DESIGN Population based cohort study. SETTING Hospital episode statistics for NHS England, including civil registration mortality data. PARTICIPANTS 58 054 elective shoulder replacements in 51 895 adults (aged ≥50 years) between April 1998 and April 2017. MAIN OUTCOME MEASURES The lifetime risk of revision surgery, calculated using an actuarial life table approach and the cumulative probability method. Rates of serious adverse events at 30 and 90 days post-surgery: pulmonary embolism, myocardial infarction, lower respiratory tract infection, acute kidney injury, urinary tract infection, cerebrovascular events, and all cause death. Secondary outcome measures were the number of surgeries performed each year and Kaplan-Meier estimates of revision risk at 3, 5, 10, and 15 years. RESULTS The number of shoulder replacements performed each year increased 5.6-fold between 1998 and 2017. Lifetime risks of revision surgery ranged from 1 in 37 (2.7%, 95% confidence interval 2.6% to 2.8%) in women aged 85 years and older to 1 in 4 (23.6%, 23.2% to 24.0%) in men aged 55-59 years. The risks of revision were highest during the first five years after surgery. The risk of any serious adverse event at 30 days post-surgery was 1 in 28 (3.5%, 3.4% to 3.7%), and at 90 days post-surgery was 1 in 22 (4.6%, 4.4% to 4.8%). At 30 days, the relative risk of pulmonary embolism compared with baseline population risk was 61 (95% confidence interval 50 to 73) for women aged 50-64. Serious adverse events were associated with increasing age, comorbidity, and male sex. 1 in 5 (21.2%, 17.9% to 25.1%) men aged 85 years and older experienced at least one serious adverse event within 90 days. CONCLUSIONS Younger patients, particularly men, need to be aware of a higher likelihood of early failure of shoulder replacement and the need for further and more complex revision replacement surgery. All patients should be counselled about the risks of serious adverse events. These risks are higher than previously considered, and for some could outweigh any potential benefits. Our findings caution against unchecked expansion of shoulder replacement surgery in both younger and older patients. The more accurate age and sex specific estimates of risk from this study are long overdue and should improve shared decision making between patients and clinicians. STUDY REGISTRATION ClinicalTrials.gov NCT03573765.
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Affiliation(s)
- Richard S Craig
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Jennifer C E Lane
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrew J Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Dominic Furniss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Jonathan L Rees
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
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