The effect of operative time on early postoperative complications in total shoulder arthroplasty: An analysis of the ACS-NSQIP database

Abstract

Background Total shoulder arthroplasty has been demonstrated to be an effective treatment for arthritis of the glenohumeral joint. Prior studies have identified longer operative times as a risk factor for complications after numerous types of procedures. We hypothesized that increased operative time, in 20-min intervals, would be associated with complications following total shoulder arthroplasty. Methods Patients undergoing total shoulder arthroplasty from 2006 to 2015 were identified from the ACS-NSQIP database. Patient demographic information, perioperative parameters, and 30-day outcomes were retrieved. Pearson's Chi-square test and multivariate Poisson regression with robust error variance were used to analyze the relationship of operative time and outcomes. Results A total of 10,082 patients were included. Multivariate analysis revealed that for each increase in 20 min of operative time, there were significantly increased rates of any complication (relative risk (RR) 1.24, 95% confidence interval (CI) 1.19–1.26), anemia requiring transfusion (RR 1.33, 95%CI 1.26–1.4), peripheral nerve injury (RR 1.88, 95%CI 1.53–2.31), and urinary tract infection (RR 1.24, 95%CI 1.09–1.41). Discussion This study indicates that increasing operative time confers increased risk for postoperative complications following total shoulder arthroplasty. We anticipate the results of this manuscript will be used for provider education, policy decision-making, and potentially to derive algorithms that can improve safety and efficiency in total shoulder arthroplasty. Level of evidence III.

A Comparison of Operative Time and Intraoperative Blood Volume Loss Between Stemless and Short‐stem Anatomic Total Shoulder Arthroplasty: A Single Institution's Experience

“…We found that the use of stemless aTSA was associated with markedly shorter surgical time compared with SS aTSA, with a median difference of 26 minutes. Wilson et al 9 found that each 20-minute increase in surgical time increased the risk for all complications by 24%. Our findings are consistent with those of Anastasio et al 6 who reported a nearly 14-minute shorter mean surgical time among the stemless cohort compared with the stemmed cohort, even when adjusting for BMI.…”

“…8 The importance of minimizing surgical time during aTSA has been previously shown to reduce the risk for perioperative complications. 9,10 The prevalence of blood transfusion after shoulder arthroplasty, as well as its associated risk factors, has previously been described. 11,12 Given the varied institutional triggers for administering a transfusion, however, has resulted in a wide range of prevalence estimates.…”

“… 8 The importance of minimizing surgical time during aTSA has been previously shown to reduce the risk for perioperative complications. 9 , 10 …”

Incidence and Risk Factors of In-hospital Prosthesis-Related Complications Following Total Shoulder Arthroplasty

“…PRCs are catastrophic complications that lead to heavy burdens on the patients as well as healthcare system [4]. Early studies have demonstrated that PRCs are associated with severe pain, disability, longer length of stay (LOS), increased rates of readmission, and higher mortality [7,8]. Most PRCs will cause revision surgeries.…”

“…Therefore, with the purpose of optimizing postoperative outcomes and reducing the requirement for revision procedures after TSA, it is imperative to determine preoperatively whether patients are at high risk of early PRCs. Numerous risk factors for the above complications have been reported by prior studies [7,[9][10][11][12][13][14][16][17][18][19][20][21][22][23][24][25][26][27][28].…”