Analysis of perioperative complications in patients after total shoulder arthroplasty and reverse total shoulder arthroplasty

Aug 27, 2014Journal of shoulder and elbow surgery

Complications Around Surgery in Patients After Standard and Reverse Total Shoulder Replacement

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Abstract

A total of 19,497 patients were analyzed, revealing higher perioperative complication rates for reverse total shoulder arthroplasty (RTSA) compared to total shoulder arthroplasty (TSA).

Patients undergoing RTSA were older, more likely to be female, and had increased rates of fractures.
RTSA was associated with significantly higher rates of perioperative mortality, pneumonia, deep venous thrombosis, myocardial infarction, urinary tract infection, and blood transfusions.
Patients in the RTSA group had longer hospital stays and higher hospital charges.
Even after adjusting for comorbidities, RTSA remained linked to increased hospital charges and longer hospitalization times.
RTSA patients experienced more blood transfusions and higher rates of pneumonia and deep venous thrombosis compared to TSA patients.

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BACKGROUND: Data directly comparing the perioperative complication rates between total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) are limited.

METHODS: The Nationwide Inpatient Sample database, which comprises data from a statistically representative sample of hospitals across the United States, was analyzed for the years 2010 and 2011. The International Classification of Diseases, Ninth Revision procedure codes differentiated the patients who received TSA (81.80) and RTSA (81.88). Demographic data, comorbidities, perioperative complications, and hospitalization data were compared.

RESULTS: This retrospective analysis included 19,497 patients, with 14,031 patients in the TSA group and 5466 patients in the RTSA group. Patients who underwent RTSA were older (P < .001), were more likely to be female (P < .001), and had increased rates of fracture (P < .001). The RTSA group had significantly higher perioperative rates of mortality (P = .004), pneumonia (P < .001), deep venous thrombosis (P < .001), myocardial infarction (P = .005), urinary tract infection (P < .001), and blood transfusions (P < .001). In addition, the RTSA patients had longer hospital stays (P < .001) and higher hospital charges (P < .001). The rates of comorbidities were also higher in the patients who underwent RTSA. After adjustment for these differences in comorbidities and surgical indications with our multivariate analysis, RTSA was still independently associated with increased hospital charges (difference of $11,530; P < .001), longer hospitalization (difference of 0.24 day; P < .001), more blood transfusions (relative risk, 1.43; P < .001) and higher rates of pneumonia (relative risk, 1.61; P = .04) and deep venous thrombosis (relative risk, 2.24; P = .01).

CONCLUSION: We found that RTSA patients, compared with TSA patients, had significantly longer length of stay, higher hospital charges that are not completely attributable to increased implant costs alone, and increased rates of perioperative complications.

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Analysis of perioperative complications in patients after total shoulder arthroplasty and reverse total shoulder arthroplasty

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