Medical Complications and Outcomes After Total Shoulder Arthroplasty: A Nationwide Analysis
TAKE HOME POINTS
- Medical complications are common (6.7%) after total shoulder arthroplasty.
- Age and preoperative medical comorbidities increased the risk of a postoperative complication.
- The most frequent medical complications are respiratory, renal, and cardiac.
- Length of stay was effected most by shock, infections, and vascular complications.
- Mortality was associated with major complications such as, shock, central nervous system, cardiac, vascular, and respiratory complications.
OUTCOMES
The primary outcome of this study was a description of the type and frequency of postoperative complications of TSA. To conduct this analysis, we queried the TSA cohort for specific ICD-9 codes representing acute cardiac, central nervous system, infectious, gastrointestinal, genitourinary, postoperative shock, renal, respiratory, surgical, vascular, and wound complications. The ICD-9 codes used to identify complications were modeled according to previous literature on various surgical applications and were further parsed to reflect only acute postoperative diagnoses13-15(see the Appendix for the comprehensive list of ICD-9 codes).
Two additional outcomes were analyzed, including postoperative mortality and LOS. Postoperative mortality was defined as death occurring prior to discharge. We calculated the average LOS among the complication and the noncomplication cohort.
STATISTICAL ANALYSIS
Patient demographics and target outcomes of the study were analyzed by frequency distribution. Where applicable, the chi-square and the Student’s t tests were used to confirm the statistical difference for dichotomous and continuous variables, respectively. Multivariate regressions were performed after controlling for possible clustering of the data using a generalized estimating equation following a previous analytical methodology.16-20 The results are reported with odds ratios and 95% confidence intervals where applicable, all statistical tests with P ≤ 0.05 were considered to be significant, and all statistical tests were two-sided. We conducted all analyses using SAS, version 9.2 (SAS Institute).
RESULTS
From 2006 to 2010, a weighted sample of 141,973 patients was found to undergo a TSA. After applying our inclusion and exclusion criteria, our study cohort consisted of 125,766 patients (Figure 1).
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