Total Shoulder Arthroplasty in Older Patients: Increased Perioperative Morbidity?

Ricchetti, Eric T.; Abboud, Joseph A.; Kuntz, Andrew F.; Ramsey, Matthew L.; Glaser, David L.; Williams, Gerald R.

doi:10.1007/s11999-010-1582-3

Cited by 53 publications

(39 citation statements)

References 30 publications

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“…Given the relatively high rate of transfusion in TSA (7%-43%) reported in the literature [15,17,30,37,41], we conducted an individual analysis of risk factors for bleeding resulting in transfusion. Previous work has demonstrated consensus regarding low patient preoperative hemoglobin percent as an independent risk factor for transfusion in the setting of TSA [15,17,30,41].…”

Section: Discussionmentioning

confidence: 99%

“…Previously, our group has used similar methods to report incidence and risk factors of complications after elective knee arthroscopy and elective shoulder arthroscopy [27,28]. We included bleeding requiring transfusion as a minor complication and also considered it as a dependent variable in a separate analysis given its previously reported rate of occurrence in TSA [15,17,30,37,41]. The reason for transfusion is not made available through NSQIP.…”

Section: Methodsmentioning

confidence: 99%

“…Previous reports have found postoperative complication rates of 2.8% to 3.6% at 30 days with exclusion of transfusion as a complication [10,43]. Bleeding resulting in transfusion has been previously studied as an individual complication in the setting of TSA with transfusion rates ranging from 7% to 43% [15,17,30,37,41]. Low preoperative hemoglobin in the setting of TSA was found to be an independent risk factor for transfusion in a number of studies [15,17,30,41].…”

Section: Introductionmentioning

confidence: 99%

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What Are Risk Factors for 30-day Morbidity and Transfusion in Total Shoulder Arthroplasty? A Review of 1922 Cases

Anthony

Westermann

Gao

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Total shoulder arthroplasty (TSA) is an effective treatment for end-stage glenohumeral joint pathology with good long-term results. Previous descriptions of morbidity and blood transfusion in TSA are limited by preoperative risk factors and postoperative complications considered and single-center studies. Questions/purposes The purpose of this study was to define in a group of patients undergoing TSA (1) the type and incidence of complications; (2) the frequency of and risk factors for both minor and major complications; and (3) the risk factors for bleeding resulting in transfusion. Methods We retrospectively queried the National Surgical Quality Improvement Program database using Current Procedural Terminology billing codes and identified 1922 cases of TSA performed between 2006 and 2011. Postoperative outcomes were divided into one of four categories: any complication, major morbidity (systemic life-threatening event or a substantial threat to a vital organ) or mortality, minor morbidity (localized to the operative upper extremity or not posing a major systemic threat to the patient), or bleeding resulting in transfusion. Univariate and multivariate analyses were then used to identify risk factors for complications.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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What Are Risk Factors for 30-day Morbidity and Transfusion in Total Shoulder Arthroplasty? A Review of 1922 Cases

Anthony

Westermann

Gao

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Although the different types of shoulder arthroplasty usually are successful for treatment of a wide range of glenohumeral disorders [4,10,15,20,31,32,46,47,49,52], the results of these procedures are unpredictably variable: a substantial number of patients having shoulder arthroplasty experience minimal to no improvement or complications. Some of the factors previously associated with poorer results include patients with shoulders with multiple surgeries before the arthroplasty, patients with shoulders with work acquired injuries, patients with comorbidities, and surgeons with limited arthroplasty experience [3, 5, 7, 17, 21, 25, 27-29, 41, 54, 56, 57].…”

Section: Introductionmentioning

confidence: 99%

What Factors are Predictive of Patient-reported Outcomes? A Prospective Study of 337 Shoulder Arthroplasties

Matsen

Russ

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Although shoulder arthroplasties generally are effective in improving patients' comfort and function, the results are variable for reasons that are not well understood. Questions/Purposes We posed two questions: (1) What factors are associated with better 2-year outcomes after shoulder arthroplasty? (2) What are the sensitivities, specificities, and positive and negative predictive values of a multivariate predictive model for better outcome? Methods Three hundred thirty-nine patients having a shoulder arthroplasty (hemiarthroplasty, arthroplasty for cuff tear arthropathy, ream and run arthroplasty, total shoulder or reverse total shoulder arthroplasty) between August 24, 2010 and December 31, 2012 consented to participate in this prospective study. Two patients were excluded because they were missing baseline variables. Forty-three patients were missing 2-year data. Univariate and multivariate analyses determined the relationship of baseline patient, shoulder, and surgical characteristics to a ''better'' outcome, defined as an improvement of at least 30% of the maximal possible improvement in the Simple Shoulder Test. The results were used to develop a predictive model, the accuracy of which was tested using a 10-fold cross-validation. Results After controlling for potentially relevant confounding variables, the multivariate analysis showed that the factors significantly associated with better outcomes were American Society of Anesthesiologists Class I (odds ratio [OR], 1.94; 95% CI, 1.03-3.65; p = 0.041), shoulder problem not related to work (OR, 5.36; 95% CI, 2.15-13.37; p \ 0.001), lower baseline Simple Shoulder Test score (OR, 1.32; 95% CI, 1.23-1.42; p \ 0.001), no prior shoulder surgery (OR, 1.79; 95% CI, 1.18-2.70; p = 0.006), humeral head not superiorly displaced on the AP radiograph (OR, 2.14; 95% CI, 1.15-4.02; p = Each author certifies that his or her institution approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. OR, 4.47; 95% CI,; p \ 0.001). Neither preoperative glenoid version nor posterior decentering of the humeral head on the glenoid were associated with the outcomes. The model predictive of a better result was driven mainly by the six factors listed above. The area under the receiver operating characteristic curve generated from the crossvalidated enhanced predictive model was 0.79 (generally values of 0.7 to 0.8 are considered fair and values of 0.8 to 0.9 are considered good). The false-positive fraction and the true-positive fraction depended on the cutoff probability selected (ie, the selected probability above which the prediction would be classified as a better outcome). A cutoff probability of 0.68 yielded the best performance of the model with cross-validation predictions of better outcomes for 236 patients (80%) and worse outcomes for 58 patients (20%); sensitivity of 91% (95% CI, 88%-95%); specificity of ...

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“…The mean UCLA Shoulder Score in kyphotic elderly patients without shoulder symptoms was approximately 32 in this study. Because of recent advances in shoulder surgery and anesthesia, shoulder arthroplasty or reconstruction surgery in the elderly population is increasing [7][8][9]. The UCLA Shoulder Score does not have an age-adjusted equation, as seen in the Constant-Murray score [10][11][12].…”

Section: Discussionmentioning

confidence: 99%

Relationship between Spinal Alignment and Glenohumeral Joint Elevation in Kyphotic Elderly Women

Yamamoto

Kubo

Yamakado

2016

JFMK

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Abstract:The purpose of this study was to evaluate the relationship between spine alignment and shoulder elevation in a kyphotic elderly population. Twenty-three consecutive female patients who underwent balloon kyphoplasty for spinal compression fractures without shoulder symptoms were examined (mean age, 76 ± 6.3 years). Thoracic kyphosis angle (TK), lumbar lordosis angle (LL), and pelvic tilt angle (PT) were measured on standing true lateral radiographs of the whole spine. The shoulder active range of motion with or without scapular fixation was measured in the sitting position. The University of California Los Angeles (UCLA) Shoulder Score was recorded as the functional evaluation. The total elevation angle was 128.9 • ± 22 • , the glenohumeral angle was 80.7 • ± 10.9 • , and the UCLA Shoulder Score was 32.4 ± 2.1. The TK was 36.7 • , the LL was −29.1 • , and the PT was 30.5 • . The total elevation angle was significantly negatively correlated with LL. TK and PT were not significantly correlated with any parameter. The total shoulder elevation angle was limited in the kyphotic elderly women in this study, and kyphotic change appeared to interfere with spinal extension and reduced the total elevation arc with no glenohumeral motion deficit. A reduction in total shoulder elevation was negatively correlated with LL.

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Total Shoulder Arthroplasty in Older Patients: Increased Perioperative Morbidity?

Cited by 53 publications

References 30 publications

What Are Risk Factors for 30-day Morbidity and Transfusion in Total Shoulder Arthroplasty? A Review of 1922 Cases

What Are Risk Factors for 30-day Morbidity and Transfusion in Total Shoulder Arthroplasty? A Review of 1922 Cases

What Factors are Predictive of Patient-reported Outcomes? A Prospective Study of 337 Shoulder Arthroplasties

Relationship between Spinal Alignment and Glenohumeral Joint Elevation in Kyphotic Elderly Women

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