title: Thirty-day morbidity and mortality after elective total shoulder arthroplasty: patient-based and surgical risk factors.
abstract: BACKGROUND
  Total shoulder arthroplasty (TSA) is an effective treatment for painful glenohumeral arthritis, but its morbidity has not been thoroughly documented.
  
  
  METHODS
  The National Surgical Quality Improvement Program database was queried to identify all patients undergoing primary TSA between 2006 and 2011, with extraction of selected patient-based or surgical variables and 30-day clinical course. Postoperative complications were stratified as major systemic, minor systemic, major local, and minor local, and mortality was recorded. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were derived from bivariate and multivariable analysis to express the association between risk factors and clinical outcomes.
  
  
  RESULTS
  Among the 2004 patients identified, the average age was 69 years, and 57% were women. Obesity was present in 46%, and 48% had an American Society of Anesthesiologists classification of ≥3. The 30-day mortality and total complication rates were 0.25% and 3.64%, respectively. Comorbid cardiac disease (OR, 85.31; 95% CI, 8.15, 892.84) and increasing chronologic age (OR, 1.19; 95% CI, 1.06, 1.33) were independent predictors of mortality, whereas peripheral vascular disease was associated with statistically significant increase in any complication (OR, 6.25; 95% CI, 1.24, 31.40). Operative time >174 minutes was an independent predictor for development of a major local complication (OR, 4.05; 95% CI, 1.45, 11.30). Obesity was not associated with any specified complication after controlling for other variables.
  
  
  CONCLUSIONS
  Whereas TSA has low short-term rates of perioperative complications and mortality, careful perioperative medical optimization and efficient surgical technique should be emphasized to decrease morbidity and mortality.
authors.affiliation: Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA. Electronic address: brian.r.waterman@us.army.mil.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Waterman
authors.affiliation: Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Dunn
authors.affiliation: Statistical Consulting Laboratory, University of Texas at El Paso, El Paso, TX, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Bader
authors.affiliation: El Paso Orthopaedic Surgery Group, Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, El Paso, TX, USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Urrea
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schoenfeld
authors.affiliation: Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Belmont
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000401:mortality / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010003:Osteoarthritis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Total shoulder arthroplasty; complications; incidence rate; mortality; risk factors