Original Research

Medical Complications and Outcomes After Total Shoulder Arthroplasty: A Nationwide Analysis

Publish date: October 4, 2018

References

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Total shoulder arthroplasty (TSA) provides a predictably high level of satisfaction with survival as high as 92% at 15 years.¹ As implant instrumentation and surgical technique and understanding have improved, the frequency of TSAs being performed has also increased.² Although there are enough data on long-term surgical complications following TSA,^1,3-6 there is a paucity of evidence delineating the incidence and types of postoperative complications during hospitalization. Several current issues motivate the improved understanding of TSA, including the increasing number of TSAs being performed, the desire to improve quality of care, and the desire to create financially efficient healthcare.

The purpose of this study is to detail the postoperative complications that occur following TSA using a large national database. Specifically, our goals are to determine the incidence and types of complications after shoulder arthroplasty, determine the patient factors that are associated with these complications, and evaluate the effects of these complications on postoperative in-hospital mortality and length of stay (LOS). Our hypothesis is that there would be a correlation between specific patient factors and complications and that these complications would adversely correlate to patient postoperative outcomes.

METHODS

DESIGN

We conducted a retrospective analysis of TSAs captured by the Nationwide Inpatient Sample (NIS) database between 2006 and 2010. The NIS is the largest all-payer inpatient database that is currently available to the public in the United States.⁷

The NIS is a part of the Healthcare Cost and Utilization Project funded by the Agency for Healthcare Research and Quality (AHRQ) and the US Department of Health and Human Services. The NIS database is designed to approximate a 20% sample of US hospitals and the patients they serve, including community, academic, general, and specialty-specific hospitals such as orthopedic hospitals.⁷ The 2010 update of the NIS database contains discharge data from 1051 hospitals across 45 states, with a representative sample of >39 million inpatient hospital stays.⁷ The NIS database and its data sources have been independently validated and assessed for quality each year since 1988.⁸Furthermore, comparative analysis of multiple database elements and distributions has been validated against standard norms, including the National Hospital Discharge Survey.⁹ The NIS database has been used in numerous published studies.^2,10,11

PATIENT SELECTION

The yearly NIS databases from 2006 to 2010 were compiled. Patients aged ≥40 years who underwent a TSA were identified using the International Classification of Diseases, 9th Revision (ICD-9), procedural code 81.80. Exclusion criteria were patients with a primary or a secondary diagnosis of humeral or scapular fracture, chronic osteomyelitis, rheumatologic diseases, or evidence of concurrent malignancy (Figure 1).

Native to NIS are patient demographics, including age, sex, and race. Patient comorbidities as described by Elixhauser and colleagues¹² are also included in the database.

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