Risk factors for and timing of adverse events after revision total shoulder arthroplasty. (October 2019)

• Record Type: Journal Article
• Authors: Keswani, Aakash; Chi, Debbie; Lovy, Andrew J; London, Daniel A; Cagle, Paul J; Parsons, Bradford O; Bosco, Joseph A
• Is Part Of: Shoulder & elbow. Volume 11:Number 5(2019)
• Page Start: 332
• Page End: 343
• Publication Date: 2019-10
• Subjects: total shoulder arthroplasty -- revision total shoulder arthroplasty -- complications -- readmission -- risk factors -- length of stay; Elbow -- Diseases -- Periodicals; Elbow -- Surgery -- Periodicals; Shoulder -- Diseases -- Periodicals; Shoulder -- Surgery -- Periodicals; Shoulder -- Periodicals; Elbow -- Periodicals; Shoulder Joint -- Periodicals; Elbow Joint -- Periodicals; 617.572005
• DOI: 10.1177/1758573218780517
• Languages: English
• ISSNs: 1758-5732

Abstract

Background: Despite increasing rates of revision total shoulder arthroplasty (RTSA), there is a paucity of literature on optimizing perioperative outcomes. The purposes of this study were to identify risk factors for unplanned readmission and perioperative complications following RTSA, risk-stratify patients based on these risk factors, and assess timing of complications. Methods: Bivariate and multivariate analyses of risk factors were assessed on RTSA patients from the ACS-NSQIP database from 2011 to 2015. Patients were risk-stratified and timing of severe adverse events and cause of readmission were evaluated. Results: Of 809 RTSA patients, 61 suffered a perioperative complication or readmission within 30 days of discharge. Multivariate analysis identified operative time, BMI > 40, infection etiology, high white blood cell count, and low hematocrit as significant independent risk factors for 30-day complications or readmission after RTSA (p ≤ 0.05). Having at least one significant risk factor was associated with 2.71 times risk of complication or readmission within 15 days compared to having no risk factors (p < 0.001). The majority of unplanned readmission, return to the operating room, open/deep wound infection, and sepsis/septic shock occurred within two weeks of RTSA. Discussion: Patients at high risk of complications and readmission after RTSA should be identified and optimized preoperatively to improve outcomes and lower costs.