title: National trends and perioperative outcomes in primary and revision total shoulder arthroplasty: Trends in total shoulder arthroplasty.
abstract: BACKGROUND
  Total shoulder arthroplasty (TSA) is a highly successful procedure for management of glenohumeral arthritis, fractures and rotator cuff tears. The purpose of this study was to evaluate patient demographics, perioperative outcomes and assess recent national trends in both primary and revision TSA.
  
  
  METHODS
  The National Hospital Discharge Survey database was searched for patients admitted to US hospitals for primary and revision TSA from 2001 to 2010.
  
  
  RESULTS
  A total of 1,297 patients who underwent primary TSA and 184 patients who underwent revision TSA were identified. The rates of primary TSA (r = 0.88) and revision TSA (r = 0.85) both demonstrated a strong positive correlation with time. The mean patient age of the primary group was significantly higher than the revision group. Gender was not significantly different between the groups. There was no significant difference in the racial make-up between the revision and primary groups. African Americans accounted for 3.3 % of primaries versus 4.3 % of revisions (p = 0.615). Revision TSA patients had a significantly longer average LOS (3.06 days vs 2.46 days, p < 0.01), more medical comorbidities (6.0 vs 5.1 comorbidities, p < 0.01) and a higher rate of developing a myocardial infarction (2.2 % versus 0 %, p < 0.01) than the primary TSA group.
  
  
  CONCLUSIONS
  This study demonstrates that the rate of TSA is rapidly increasing in the US, with over a four-fold increase in revisions and five-fold increase in primaries over the ten years studied.
authors.affiliation: Department of Orthopedic Surgery, University of Illinois at Chicago, 835 S. Wolcott Avenue, Room E270, M/c 844, Chicago, IL, 60612, USA.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Schwartz
authors.forename: David D
authors.initials: DD
authors.lastname: Savin
authors.forename: Ari R
authors.initials: AR
authors.lastname: Youderian
authors.forename: David
authors.initials: D
authors.lastname: Mossad
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000379:methods* / Q000639:trends; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000639:trends*; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult