Total shoulder arthroplasty: risk factors for intraoperative and postoperative complications in patients with primary arthritis

J Shoulder Elbow Surg. 2017 Mar;26(3):e71-e77. doi: 10.1016/j.jse.2016.08.001. Epub 2016 Oct 10.


Background: This study evaluated and identified risk factors for the development of intraoperative and postoperative surgical complications in total shoulder arthroplasty in patients with primary osteoarthritis.

Methods: We evaluated patient-specific factors, including age, sex, body mass index, prior nonarthroplasty surgery, smoking, alcohol consumption, and the American Society of Anesthesiologists (ASA) Physical Status Classification System in 275 patients (76 men, 199 women) with an average age of 68 years (range, 51-85 years). We categorized the number and severity of all complications and correlated these results with the patient-specific factors RESULTS: Twenty-seven complications (9.8%) in 275 shoulder arthroplasties were recorded. We identified 22 patients (8%) with category I complications and 5 (2.8%) with category II complications. Patients with an ASA score of 3 showed an increased likelihood of having a surgical complication compared with the control group with ASA scores of 1 and 2 (odds ratio, 4.28; 95% confidence interval, 1.79-10.20; P < .01). Smokers were more prone to surgical complications than nonsmokers (odds ratio, 5.08; 95% confidence interval, 1.96-13.11; P = .02).

Conclusion: Surgical complication rates after anatomic total shoulder arthroplasty in patients with primary osteoarthritis correlate with the patient's overall health status and nicotine consumption. This may be useful for predicting the likelihood of surgical complications and may thus prove important for clinicians to better assess and explain possible risks before surgery.

Keywords: ASA; BMI; Total shoulder arthroplasty; intraoperative complications; nicotine consumption; postoperative complications; risk factors.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthritis / surgery*
  • Arthroplasty, Replacement, Shoulder / adverse effects*
  • Female
  • Germany / epidemiology
  • Humans
  • Incidence
  • Intraoperative Complications / epidemiology*
  • Male
  • Middle Aged
  • Odds Ratio
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Risk Assessment*
  • Risk Factors
  • Shoulder Joint / surgery*