Total Shoulder Arthroplasty Demographics, Incidence, and Complications—A Nationwide Inpatient Sample Database Study

Abstract:

Introduction: Total shoulder arthroplasty (TSA) has become a popular and successful surgery to treat advanced glenohumeral arthritis, rotator cuff arthropathy, and proximal humerus fractures. Historical data is available investigating the epidemiology of total shoulder arthroplasty with regard to patient characteristics, outcomes, and complications; however, there is a lack of studies investigating the most recent and up to date national trends related to shoulder replacement. The purpose of this study was to evaluate changes in the annual incidence, various demographics, and complications of TSA in America. Materials and Methods: The Nationwide Inpatient Sample (NIS) was assessed to identify all patients who were admitted for TSA in the United States between 1998 and 2010. National trends in patient demographics, incidence, and length-of-stay (LOS) were analyzed for correlations. The impacts of contributing factors to each outcome were assessed using adjusted multivariable regression analysis. These were used to calculate odds ratios of cohort demographics and their association with complications and LOS. Results: Admissions for TSA have risen (8,041 to 39,072 admissions). The majority of the cohort consisted of Caucasian men between the ages of 64 and 79 years. The incidence rate of complications has remained consistent. Female gender, age > 80 years, and higher Deyo Comorbidity scores were risk factors for higher complications. The LOS has decreased (2.96 to 2.21 days) during the study time period. Female gender, African-American race, Medicaid insurance, and higher Deyo Comorbidity scores were associated with longer stays. Discussion: Our study demonstrates a rapid increase in incidence rates of TSAs within the 13-year period in the United States. An increased risk of complications was noted with older age, female gender, and increased Deyo score. Conclusion: Our findings may help health care providers identify ways to better manage this procedure and select patients.

Authors:

Kimona Issa, MD, PGY3 Resident, Department of Orthopaedics, Seton Hall University, School of Health and Medical Sciences, South Orange, NJ, Casey M. Pierce, MD, PGY5 Resident, Department of Orthopaedics, Seton Hall University, School of Health and Medical Sciences, South Orange, NJ, Todd P. Pierce, MD, Research Fellow, Department of Orthopaedics, Seton Hall University, School of Health and Medical Sciences, South Orange, NJ, Matthew R. Boylan, ScB, Medical Student, Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, Bashir A. Zikria, MD, MSC, Associate Professor, Department of Orthopaedic Surgery, John Hopkins University Hospital, Baltimore, MD, Qais Naziri, MD, MBA, PGY3 Resident, Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, Anthony Festa, MD, Associate Professor, Department of Orthopaedics, Seton Hall University, School of Health and Medical Sciences, South Orange, NJ, Vincent K. McInerney, MD, Residency Program Director, Department of Orthopaedics, Seton Hall University, School of Health and Medical Sciences, South Orange, NJ, Anthony J. Scillia, MD, Associate Professor, Department of Orthopaedics, Seton Hall University, School of Health and Medical Sciences, South Orange, NJ

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