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

Autor: Bixby EC; Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA., Boddapati V; Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA., Anderson MJJ; Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA., Mueller JD; Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA., Jobin CM; Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA., Levine WN; Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA.
Jazyk: angličtina
Zdroj: JSES international [JSES Int] 2020 Jun 07; Vol. 4 (3), pp. 657-661. Date of Electronic Publication: 2020 Jun 07 (Print Publication: 2020).
DOI: 10.1016/j.jseint.2020.04.024
Abstrakt: Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
(© 2020 The Authors.)
Databáze: MEDLINE
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