title: In-hospital mortality risk for total shoulder arthroplasty: A comprehensive review of the medicare database from 2005 to 2011.
abstract: BACKGROUND
  The in-hospital mortality rate after total shoulder arthroplasty (TSA) is unknown. The purpose of this study is to quantify the in-patient mortality rates and associated demographic risk factors for patients undergoing a TSA from 2005 to 2011 using a comprehensive Medicare registry database.
  
  
  METHODS
  We conducted a retrospective review of the Medicare database within the PearlDiver database. The PearlDiver database is a publicly available Health Insurance Portability and Accountability Act-compliant national database that captures 100% of the Medicare hospital data for TSA between 2005 and 2011. Using International Classification of Diseases, Ninth Revision codes for TSA we identified a dataset of patients undergoing TSA as well as a subset of those for whom there was a death discharge (i.e., in-patient death). Risk for this outcome was further quantified by age, gender and year. Linear regression was performed to identify risk factors for the primary outcome.
  
  
  RESULTS
  A total of 101,323 patients underwent 125,813 TSAs between 2005 and 2011. There were 113 in-patient mortalities during this period. Thus the incidence of death was 0.09%. Increasing age was a significant risk factor for mortality (P = 0.03). Gender and year of procedure were not significant risk factors for mortality.
  
  
  CONCLUSIONS
  The incidence of in-patient mortality for Medicare patients undergoing TSA between 2005 and 2011 was <1 in 1000 surgeries. Increased age is a significant predictor of mortality.
  Retrospective analysis.
authors.affiliation: Holy Cross Orthopedic Institute, Holy Cross Hospital, Fort Lauderdale, FL, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: McCormick
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Benedict U
authors.initials: BU
authors.lastname: Nwachukwu
authors.affiliation: Holy Cross Orthopedic Institute, Holy Cross Hospital, Fort Lauderdale, FL, USA.
authors.forename: Emmanouil B S
authors.initials: EB
authors.lastname: Kiriakopoulos
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: William W
authors.initials: WW
authors.lastname: Schairer
authors.affiliation: Department of Sports Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Provencher
authors.affiliation: Holy Cross Orthopedic Institute, Holy Cross Hospital, Fort Lauderdale, FL, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Levy
keywords: Complications; Medicare; in-hospital mortality; reverse total shoulder replacement; total shoulder replacement