Shoulder Arthroplasty for Posttraumatic Arthritis Is Associated With Increased Transfusions and Longer Operative Times
Introduction: Posttraumatic arthritis (PTA) is a common sequela of proximal humerus fractures that is commonly managed with anatomic or reverse total shoulder arthroplasty (TSA). TSA for PTA is more challenging than that performed for primary osteoarthritis and frequently leads to worse patient outc...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2019-10-01
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| Series: | Journal of Shoulder and Elbow Arthroplasty |
| Online Access: | https://doi.org/10.1177/2471549219882133 |
| _version_ | 1818609990259179520 |
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| author | Tyler A Luthringer MD Benjamin S Kester MD Oluwadamilola Kolade MD Mandeep S Virk MD Michael J Alaia MD Kirk A Campbell MD |
| author_facet | Tyler A Luthringer MD Benjamin S Kester MD Oluwadamilola Kolade MD Mandeep S Virk MD Michael J Alaia MD Kirk A Campbell MD |
| author_sort | Tyler A Luthringer MD |
| collection | DOAJ |
| description | Introduction: Posttraumatic arthritis (PTA) is a common sequela of proximal humerus fractures that is commonly managed with anatomic or reverse total shoulder arthroplasty (TSA). TSA for PTA is more challenging than that performed for primary osteoarthritis and frequently leads to worse patient outcomes. CPT uniformly classifies all cases of primary TSA, irrespective of procedural complexity and resource utilization. This study analyzes intraoperative differences and 30-day outcomes for anatomic and reverse TSA performed in the posttraumatic shoulder. Methods: Patients undergoing TSA from 2008 to 2015 were selected from the National Surgical Quality Improvement Program database and stratified according to concurrent procedures and administrative codes indicating posttraumatic diagnoses. Perioperative parameters and 30-day complications were recorded; multivariate analyses were performed to determine whether PTA was a risk factor for poor outcomes. Results: A total of 8508 primary and 243 posttraumatic TSAs were identified. Posttraumatic TSA patients were slightly younger ( P = .003), more likely to be female ( P < .001), smokers ( P = .029), and diabetic ( P = .003). Diagnosis of PTA was an independent risk factor for prolonged operative times ≥160 minutes (≥1 standard deviation above the mean, P = .003; odds ratio [OR]: 1.718; 95% confidence interval [CI]: 1.204–2.449) and increased bleeding requiring transfusion ( P < .001; OR: 2.719; 95% CI: 1.607–4.600). Although posttraumatic TSA had a tendency for longer hospital admissions, 30-day readmissions were not significantly different between cohorts. Conclusions: Compared with primary osteoarthritis, a preoperative diagnosis of PTA is an independent risk factor for prolonged operative times and postoperative transfusion in anatomic or reverse TSA patients; such patients may be less than optimal candidates for same-day discharges or outpatient shoulder arthroplasty. |
| first_indexed | 2024-12-16T15:07:19Z |
| format | Article |
| id | doaj.art-f0f2da3f9e6e46ceb60339ad37184d31 |
| institution | Directory Open Access Journal |
| issn | 2471-5492 |
| language | English |
| last_indexed | 2024-12-16T15:07:19Z |
| publishDate | 2019-10-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Shoulder and Elbow Arthroplasty |
| spelling | doaj.art-f0f2da3f9e6e46ceb60339ad37184d312022-12-21T22:27:06ZengSAGE PublishingJournal of Shoulder and Elbow Arthroplasty2471-54922019-10-01310.1177/2471549219882133Shoulder Arthroplasty for Posttraumatic Arthritis Is Associated With Increased Transfusions and Longer Operative TimesTyler A Luthringer MDBenjamin S Kester MDOluwadamilola Kolade MDMandeep S Virk MDMichael J Alaia MDKirk A Campbell MDIntroduction: Posttraumatic arthritis (PTA) is a common sequela of proximal humerus fractures that is commonly managed with anatomic or reverse total shoulder arthroplasty (TSA). TSA for PTA is more challenging than that performed for primary osteoarthritis and frequently leads to worse patient outcomes. CPT uniformly classifies all cases of primary TSA, irrespective of procedural complexity and resource utilization. This study analyzes intraoperative differences and 30-day outcomes for anatomic and reverse TSA performed in the posttraumatic shoulder. Methods: Patients undergoing TSA from 2008 to 2015 were selected from the National Surgical Quality Improvement Program database and stratified according to concurrent procedures and administrative codes indicating posttraumatic diagnoses. Perioperative parameters and 30-day complications were recorded; multivariate analyses were performed to determine whether PTA was a risk factor for poor outcomes. Results: A total of 8508 primary and 243 posttraumatic TSAs were identified. Posttraumatic TSA patients were slightly younger ( P = .003), more likely to be female ( P < .001), smokers ( P = .029), and diabetic ( P = .003). Diagnosis of PTA was an independent risk factor for prolonged operative times ≥160 minutes (≥1 standard deviation above the mean, P = .003; odds ratio [OR]: 1.718; 95% confidence interval [CI]: 1.204–2.449) and increased bleeding requiring transfusion ( P < .001; OR: 2.719; 95% CI: 1.607–4.600). Although posttraumatic TSA had a tendency for longer hospital admissions, 30-day readmissions were not significantly different between cohorts. Conclusions: Compared with primary osteoarthritis, a preoperative diagnosis of PTA is an independent risk factor for prolonged operative times and postoperative transfusion in anatomic or reverse TSA patients; such patients may be less than optimal candidates for same-day discharges or outpatient shoulder arthroplasty.https://doi.org/10.1177/2471549219882133 |
| spellingShingle | Tyler A Luthringer MD Benjamin S Kester MD Oluwadamilola Kolade MD Mandeep S Virk MD Michael J Alaia MD Kirk A Campbell MD Shoulder Arthroplasty for Posttraumatic Arthritis Is Associated With Increased Transfusions and Longer Operative Times Journal of Shoulder and Elbow Arthroplasty |
| title | Shoulder Arthroplasty for Posttraumatic Arthritis Is Associated With Increased Transfusions and Longer Operative Times |
| title_full | Shoulder Arthroplasty for Posttraumatic Arthritis Is Associated With Increased Transfusions and Longer Operative Times |
| title_fullStr | Shoulder Arthroplasty for Posttraumatic Arthritis Is Associated With Increased Transfusions and Longer Operative Times |
| title_full_unstemmed | Shoulder Arthroplasty for Posttraumatic Arthritis Is Associated With Increased Transfusions and Longer Operative Times |
| title_short | Shoulder Arthroplasty for Posttraumatic Arthritis Is Associated With Increased Transfusions and Longer Operative Times |
| title_sort | shoulder arthroplasty for posttraumatic arthritis is associated with increased transfusions and longer operative times |
| url | https://doi.org/10.1177/2471549219882133 |
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