title: Total shoulder arthroplasty in older patients: increased perioperative morbidity?
abstract: BACKGROUND
  More elderly patients are becoming candidates for total shoulder arthroplasty with an increase in frequency of the procedure paralleling the rise in other total joint arthroplasties. Controversy still exists, however, regarding the perioperative morbidity of total joint arthroplasty in elderly patients, particularly those 80 years of age and older.
  
  
  OBJECTIVE
  We asked whether perioperative complications and mortality, transfusion requirements, inpatient length of stay, and discharge disposition after total shoulder arthroplasty were similar in patients 80 years and older compared with those in younger patients.
  
  
  METHODS
  We retrospectively compared the 90-day complications, mortality, and other perioperative variables after total shoulder arthroplasty in 40 patients (43 shoulders) aged 80 years and older (Group A; mean age, 82 years) with 46 patients (47 shoulders) younger than 70 years (Group B; mean age, 61 years).
  
  
  RESULTS
  We found no differences in complication rates between Group A and B, including systemic (26% versus 11%) and local (5% versus 9%) complications or major (7% versus 2%) and minor (23% versus 17%) complications. There were no deaths in either group. Group A had an increased transfusion requirement (16% versus 2%) and a decreased number of direct to home discharges (67% versus 98%). Presence of systemic complications predicted increased length of stay in patients overall and in Group A patients.
  
  
  CONCLUSIONS
  Total shoulder arthroplasty can be performed in patients 80 years and older with rates of perioperative complications and mortalities comparable to those of younger patients, although these older patients may require a longer period of institutional care before return to home and may be more likely to require a blood transfusion.
  
  
  METHODS
  Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
authors.forename: Eric T
authors.initials: ET
authors.lastname: Ricchetti
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Abboud
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Kuntz
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Ramsey
authors.forename: David L
authors.initials: DL
authors.lastname: Glaser
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Williams
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000401:mortality; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge; D018579:Patient Selection; D059035:Perioperative Period; D015143:Philadelphia; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012785:Shoulder Joint / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome