Thirty-day morbidity and mortality after elective total shoulder arthroplasty: patient-based and surgical risk factors

J Shoulder Elbow Surg. 2015 Jan;24(1):24-30. doi: 10.1016/j.jse.2014.05.016. Epub 2014 Aug 29.


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.

Keywords: Total shoulder arthroplasty; complications; incidence rate; mortality; risk factors.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement / mortality
  • Arthroplasty, Replacement / statistics & numerical data*
  • Elective Surgical Procedures / mortality
  • Elective Surgical Procedures / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • Morbidity
  • Osteoarthritis / surgery*
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Shoulder Joint / surgery*
  • Treatment Outcome
  • United States / epidemiology