Short-Term Complications and Readmission Following Total Shoulder Arthroplasty: A National Database Study

The incidence of total shoulder arthroplasty (anatomic and reverse) is increasing as indications expand.The purpose of this study is to identify predictors of short-term complications and readmission following total shoulderarthroplasty for patients with glenohumeral osteoarthritis. The American College of Surgeons National Surgical Quality Improvement Program was used to identify12,982 patients who underwent total shoulder arthroplasty (anatomic or reverse) from 2011-2016. Demographic data,postoperative complications, and readmission within 30 days were analyzed. Multivariable logistic regression was usedto determine independent risk factors for complications and for readmission occurring within 30 days of surgery. The mean age of the cohort was 69.1 years, 56.1% were female. Mean American Society ofAnesthesiologists (ASA) classification score was 2.6. The postoperative complication rate was 5.6% and thereadmission rate was 2.8% within 30 days of surgery. Independent predictors for any complication includedpreoperative dependent functional status (OR 1.8, p <0.001), ASA class 3 (OR 3.6, P=0.021) and 4 (OR 8.5,p <0.001), age 70-79 (OR 1.4, P=0.019) age ≥ 80 years (OR 2.3, p <0.001, and female gender (OR 1.6, P=0.001).Independent predictors for readmission included congestive heart failure (OR 3.4, P=0.002) and ASA class 4(OR 14, P = 0.013). Independent functional status was associated with decreased odds of readmission (OR 0.4,p <0.001). Patients with age greater than 70 years, congestive heart failure, and ASA class 3 and 4 are at increasedrisk for postoperative complications and readmission. Preoperative risk stratification and medical optimization areimportant in these patients.Level of evidence: III