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Original Research
Medical Complications and Outcomes After Total Shoulder Arthroplasty: A Nationwide Analysis
Authors’ Disclosure Statement: Dr. Jobin reports that he has received consultant payments from Acumed, Depuy Synthes, Wright-Tornier, and Zimmer Biomet, which is not directly related to the subject of this work; receives grant support from American Shoulder & Elbow Surgeons and grant funding from Orthopedic Scientific Research Foundation not related to the subject of this work; and he is on the editorial board of the Journal of American Academy of Orthopedic Surgeons (JAAOS). Dr. Levine reports that he is an unpaid consultant for Zimmer Biomet, receives research grant financial support from Smith and Nephew not directly related to the subject of this work, and is on the editorial/governing board of the Journal of American Academy of Orthopedic Surgeons (JAAOS). Dr. Ahmad reports that he receives intellectual property royalties, is a paid consultant to, and receives research support from Arthrex; receives stock or stock options from At Peak; receives publishing royalties and financial or material support from Lead Player; receives research support from Major League Baseball; receives research support from Stryker; and is on the editorial or governing board for Orthopedics Today. The other authors report no actual or potential conflict of interest in relation to this article.
Dr. Anakwenze is an Orthopedic Surgeon, Olympus Orthopedic Medical Group, San Diego, California. Dr. O’Donnell is a Resident, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York. Dr. Jobin, Dr. Levine, and Dr. Ahmad are Orthopedic Surgeons, Department of Orthopedic Surgery, Columbia University, New York, New York.
Address correspondence to: Oke A Anakwenze, MD, Olympus Orthopedic Medical Group, 3750 Convoy Street, Suite 201, San Diego, CA 92111 (email, oaa@olympusortho.com).
Oke A. Anakwenze, MD Evan A. O’Donnell, BA Charles M. Jobin, MDWilliam N. Levine, MD Christopher S. Ahmad, MD . Medical Complications and Outcomes After Total Shoulder Arthroplasty: A Nationwide Analysis. Am J Orthop.
October 4, 2018
References
OUTCOMES
The primary outcome of this study was a description of the type and frequency of postoperative complications of TSA. To conduct this analysis, we queried the TSA cohort for specific ICD-9 codes representing acute cardiac, central nervous system, infectious, gastrointestinal, genitourinary, postoperative shock, renal, respiratory, surgical, vascular, and wound complications. The ICD-9 codes used to identify complications were modeled according to previous literature on various surgical applications and were further parsed to reflect only acute postoperative diagnoses13-15(see the Appendix for the comprehensive list of ICD-9 codes).
Two additional outcomes were analyzed, including postoperative mortality and LOS. Postoperative mortality was defined as death occurring prior to discharge. We calculated the average LOS among the complication and the noncomplication cohort.
STATISTICAL ANALYSIS
Patient demographics and target outcomes of the study were analyzed by frequency distribution. Where applicable, the chi-square and the Student’s t tests were used to confirm the statistical difference for dichotomous and continuous variables, respectively. Multivariate regressions were performed after controlling for possible clustering of the data using a generalized estimating equation following a previous analytical methodology.16-20 The results are reported with odds ratios and 95% confidence intervals where applicable, all statistical tests with P ≤ 0.05 were considered to be significant, and all statistical tests were two-sided. We conducted all analyses using SAS, version 9.2 (SAS Institute).
RESULTS
From 2006 to 2010, a weighted sample of 141,973 patients was found to undergo a TSA. After applying our inclusion and exclusion criteria, our study cohort consisted of 125,766 patients (Figure 1).
