Congestive heart failure and renal failure in total shoulder arthroplasty: a national database study

Abstract

BackgroundCongestive heart failure and renal failure are volume sensitive pathologies that lead to significant morbidity and mortality. Due to the aging population in the United States, more patients with volume sensitivity are expected to undergo shoulder arthroplasty. The purpose of this study was to determine the effect of volume sensitive comorbidities on acute postoperative outcomes following shoulder arthroplasty. MethodsThe American College of Surgeons National Surgical Quality Improvement Program was used to identify patients who underwent primary elective shoulder arthroplasty from January 1, 2011 to December 31, 2018. Patients who were diagnosed with volume sensitive diseases (congestive heart failure, kidney failure, and dialysis) were compared with non-volume sensitive patients. Demographic data, length of hospital stay, and postoperative complications within 30 days were analyzed. Multivariable logistic regression was used isolate the effect of volume sensitivity on postoperative complications and readmission. ResultsA total of 23,761 patients underwent shoulder arthroplasty and 218 (0.9%) were volume sensitive. The overall adverse event rate across all patients was 6.5%. On univariate analysis, volume sensitive patients were more likely to need a reoperation within 30 days, require readmission within 30 days, have a minor or major complication, and were less likely to be discharged home (P < .05). However, multivariable logistic analysis found that volume sensitive comorbidities were not independently associated with readmission or major complications. Increasing age and higher ASA classification were associated with increased odds of both major and minor complications, and reduced odds of discharge home ConclusionThere is an increased rate of adverse acute outcomes following shoulder arthroplasty in the volume sensitive population which may be a result of comorbid factors, such as dependent functional status, increasing age, and higher ASA classification. Level of EvidenceLevel III; Retrospective Case-Control Study