Trends in total shoulder arthroplasty from 2005 to 2018: lower complications rates and shorter lengths of stay despite patients with more comorbidities

• Published in: JSES international Vol. 4; no. 3; pp. 657 - 661
• Main Authors: Bixby, Elise C., Boddapati, Venkat, Anderson, Matthew J.J., Mueller, John D., Jobin, Charles M., Levine, William N.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2020; Elsevier
• Subjects: ACS-NSQIP; Complications; Length of stay; NSQIP; Outcomes; Shoulder; Total shoulder arthroplasty; Epidemiology Study; NSQIP; Complications; Retrospective Cohort Comparison Using Large Database; ACS-NSQIP; Total shoulder arthroplasty; Outcomes; Level III; Length of stay
• ISSN: 2666-6383; 2666-6383
• DOI: 10.1016/j.jseint.2020.04.024

Total shoulder arthroplasty (TSA) is an increasingly common procedure. This study looked at trends in TSA using a nationwide registry, with a focus on patient demographics, comorbidities, and complications.
The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent TSA from 2005 to 2018. Cohorts were created based on year of surgery: 2005-2010 (N = 1116), 2011-2014 (N = 5920), and 2015-2018 (N = 16,717). Patient demographics, comorbidities, operative time, hospital length of stay, discharge location, and complications within 30 days of surgery were compared between cohorts using bivariate and multivariate analysis.
Bivariate analysis revealed significantly more comorbidities among patients in the 2015-2018 cohort compared with the 2005-2010 cohort, specifically American Society of Anesthesiologist class III or IV (57.0% vs. 44.3%, P < .001), morbid obesity (10.8% vs. 7.8%, P < .001), diabetes (17.8% vs. 12.1%, P < .001), and chronic obstructive pulmonary disease (6.7% vs. 4.1%, P = .003). The use of regional anesthesia has decreased (5.6% in 2005-2010 vs. 2.8% in 2015-2018, P < .001), as has operative time (▵: −16 minutes, P < .001) and length of stay (▵: −0.6 days, P < .001). There were also significant decreased rates of perioperative blood transfusion (OR [odds ratio], 0.46), non-home discharge (OR, 0.79), urinary tract infection (OR, 0.47), and sepsis (OR, 0.17), (P < .001 for all comparisons) between the 2005-2010 and 2015-2018 cohorts.
Between 2005 and 2018, patients undergoing TSA had increasingly more comorbidities but experienced lower rates of short-term complications, in the context of shorter hospitalizations and more frequent discharge to home.