Total shoulder arthroplasty in octogenarians: Is there a higher risk of adverse outcomes?

Abstract

This study used the National Surgical Quality Improvement Program to evaluate octogenarians who underwent total shoulder arthroplasty (TSA). Specifically, we evaluated: (1) patient demographics; (2) perioperative factors; and (3) 30-day postoperative complications. Compared to controls, the octogenarians had more females, white patients, lower BMIs, fewer smokers, less functionally independent, higher ASA scores, shorter operative times, and longer LOS. Octogenarians had greater odds for developing any (OR = 2.05; 95%CI, 1.70-2.46), any major (OR = 2.28; 95%CI, 1.66-3.13), and any minor (OR = 1.99; 95%CI, 1.63-2.45) complications. Perioperative risk management strategies for elective TSA in the elderly may help mitigate the increased perioperative risks associated with age.

Serious adverse events and lifetime risk of reoperation after elective shoulder replacement: population based cohort study using hospital episode statistics for England

“… 39 Studies that do present risk estimates at 30 and 90 days post-surgery are typically limited by small sample size and again are skewed by the inclusion of trauma and revision procedures. 40 41 42 We did not include additional estimates of symptomatic deep vein thrombosis in our study.…”

Short-Term Outcomes After Total Shoulder Arthroplasty in Octogenarians: A Matched Analysis

“…One study similarly found a higher overall complication rate in octogenarians. However, this group also found that octogenarians were at a higher risk of several, specific major and minor complications within 30 days including pulmonary embolism, stroke, myocardial infarction, reintubation and septic shock [ 11 ]. The differences between our results and the aforementioned study are likely due to the fact that the aforementioned study did not create two equal sized groups, but rather compared all TSA patients in the database for a set time period.…”

“…Age has often been identified as a risk factor for complication throughout the orthopaedic literature [11][12][13][14]. However, this risk factor is non-modifiable, and with an aging population in the United States, there is a need for surgeons to better understand the impact of age on orthopaedic outcomes.…”

“…Octogenarians (i.e. individuals of age 80 or older) have been the subject of numerous outcome studies in arthroplasty which have shown this group to be at a higher risk of complication [11][12][13]15,16]. The purpose of this study was to determine if octogenarians have poorer outcomes after total shoulder arthroplasty compared to a younger, matched control group.…”

“…While TSA can provide excellent outcomes for patients with a variety of glenohumeral pathologies, the procedure is not risk free. Periprosthetic fracture, implant failure, peri-operative medical complications and infection are all serious complications of TSA that can lead to reoperation, diminished functional results, or even death if not managed in a timely and appropriate manner [ 10 , 11 ]. Hence, it is crucial that surgeons be meticulous in selecting appropriate patients for TSA and remain aware of risk factors for poor outcomes and complications.…”