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Elective Total Shoulder Arthroplasty in Octogenarians

A Safe Procedure

Bovonratwet, Patawut, BS; Malpani, Rohil, BS; Ondeck, Nathaniel T., BS; Tyagi, Vineet, MD; Grauer, Jonathan N., MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: February 15, 2019 - Volume 27 - Issue 4 - p 145–154
doi: 10.5435/JAAOS-D-17-00364
Research Article

Introduction: There has been a lack of studies investigating the perioperative course of total shoulder arthroplasty (TSA) performed in the increasingly octogenarian (≥80 years old) population in a large sample size. The purpose of this study was to compare perioperative complications between primary TSA performed in octogenarians and that performed in younger populations (<70 and 70 to 79 years old) from the National Surgical Quality Improvement Program database.

Methods: Patients who underwent primary TSA between January 2005 and December 2015 were identified from the National Surgical Quality Improvement Program database and stratified into three age groups: <70, 70 to 79, and ≥80 years old. Patient characteristics and comorbidities were compared between the three groups. Propensity score-matched comparisons were then performed for length of hospital stay, 30-day perioperative complications, and readmissions. Risk factors and reasons for readmission in the octogenarians were characterized.

Results: This study included 3,007 patients who were <70 years old, 2,155 patients who were 70 to 79 years old, and 900 octogenarian patients. Statistical analysis was carried out after matching for propensity score. While no significant differences in perioperative complications were observed between the octogenarians and 70- to 79-year-olds, significantly higher rates of readmission (4.2% versus 1.7%; P = 0.002), pneumonia (1.1% versus 0.0%; P = 0.002), and urinary tract infection (1.8% versus 0.2%; P = 0.001) were found in the octogenarians compared with <70-year-olds. In addition, the octogenarians also had a slightly longer length of hospital stay compared with the younger populations (0.6 days longer than <70-year-olds and 0.4 days longer than 70- to 79-year-olds; both P < 0.001).

Conclusion: These data suggest that primary TSA can safely be considered for octogenarians with only mildly increased morbidities. However, greater preoperative optimization or post-discharge care for octogenarians may be warranted to reduce the rates of readmission.

From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.

Correspondence to Dr. Grauer:

Dr. Grauer or an immediate family member serves as a paid consultant to Bioventus, Medtronic, and Stryker; and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, the Cervical Spine Research Society, the Lumbar Spine Research Society, and the North American Spine Society. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Mr. Bovonratwet, Mr. Malpani, Mr. Ondeck, and Dr. Tyagi.

© 2019 by American Academy of Orthopaedic Surgeons
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