Abstract
BackgroundExamine 90-day postoperative mortality and its predictors following shoulder arthroplastyMethodsWe identified vital status of all adults who underwent primary shoulder arthroplasty (Total shoulder arthroplasty (TSA) or humeral head replacement (HHR)) at the Mayo Clinic from 1976-2008, using the prospectively collected information from Total Joint Registry. We used univariate logistic regression models to assess the association of gender, age, body mass index, American Society of Anesthesiologist (ASA) class, Deyo-Charlson comorbidity index, an underlying diagnosis and implant fixation with odds of 90-day mortality after TSA or HHR. Multivariable models additionally adjusted for the type of surgery (TSA versus HHR). Adjusted Odds ratio (OR) with 95% confidence interval (CI) were calculated.ResultsTwenty-eight of the 3, 480 patient operated died within 90-days of shoulder arthroplasty (0.8%). In multivariable-adjusted analyses, the following factors were associated with significantly higher odds of 90-day mortality: higher Deyo-Charlson index (OR, 1.54; 95% CI:1.39, 1.70; p < 0.001); a diagnosis of tumor (OR, 16.2; 95%CI:7.1, 36.7); and ASA class III (OR, 3.57; 95% CI:1.29, 9.91; p = 0.01) or class IV (OR, 13.4; 95% CI:2.44, 73.86; p = 0.003). BMI ≥ 30 was associated with lower risk of 90-day mortality (OR, 0.25; 95% CI:0.08, 0.78). In univariate analyses, patients undergoing TSA had significantly lower 90-day mortality of 0.4% (8/2, 580) compared to 1% in HHR (20/1, 411) (odds ratio, 0.22 (95% CI: 0.10, 0.50); p = 0.0003).Conclusions90-day mortality following shoulder arthroplasty was low. An underlying diagnosis of tumor, higher comorbidity and higher ASA class were risk factors for higher 90-day mortality, while higher BMI was protective. Pre-operative comorbidity management may impact 90-day mortality following shoulder arthroplasty. A higher unadjusted mortality in patients undergoing TSA versus HHR may indicate the underlying differences in patients undergoing these procedures.
Highlights
Examine 90-day postoperative mortality and its predictors following shoulder arthroplasty
Differences between Total shoulder arthroplasty (TSA) and humeral head replacement (HHR) In univariate analyses, patients undergoing TSA had significantly lower 90-day mortality of 0.4% (8/2, 580) compared to 1% in HHR (20/1, 411) (odds ratio, 0.22; p = 0.0003)
In this study, we found that 90-day mortality following primary shoulder arthroplasty was 0.8% using 33-year data from a larger medical center
Summary
Examine 90-day postoperative mortality and its predictors following shoulder arthroplasty. Shoulder arthroplasty is an effective surgical procedure for the treatment of refractory shoulder pain due to end stage shoulder disease due to osteoarthritis and other causes It is associated with improvement in shoulder pain, function and quality of life. Smaller studies, which were likely underpowered, and had shorter follow-up have reported lower mortality: 30-day mortality of 0.4% in 793 TSA patient from Veterans Affairs medical centers [4] and no inhospital deaths in 994 shoulder arthroplasties in a discharge database from Maryland [5]. Our aims were to: (1) determine the risk factors and rate of 90-day mortality following primary shoulder arthroplasty (TSA or HHR); and (2) if data allowed, to assess whether mortality differed by the type of procedure (TSA versus HHR)
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