Thirty-day morbidity and mortality after elective total shoulder arthroplasty: Patient-based and surgical risk factors

Brian R. Waterman*, John C. Dunn, Julia Bader, Luis Urrea, Andrew J. Schoenfeld, Philip J. Belmont

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

116 Scopus citations


Background: Total shoulder arthroplasty (TSA) is an effective treatment for painful glenohumeral arthritis, but its morbidity has not been thoroughly documented. Methods: The National Surgical Quality Improvement Program database was queried to identify all patients undergoing primary TSA between 2006 and 2011, with extraction of selected patient-based or surgical variables and 30-day clinical course. Postoperative complications were stratified as major systemic, minor systemic, major local, and minor local, and mortality was recorded. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were derived from bivariate and multivariable analysis to express the association between risk factors and clinical outcomes. Results: Among the 2004 patients identified, the average age was 69years, and 57% were women. Obesity was present in 46%, and 48% had an American Society of Anesthesiologists classification of ≥3. The 30-day mortality and total complication rates were 0.25% and 3.64%, respectively. Comorbid cardiac disease (OR, 85.31; 95% CI, 8.15, 892.84) and increasing chronologic age (OR, 1.19; 95% CI, 1.06, 1.33) were independent predictors of mortality, whereas peripheral vascular disease was associated with statistically significant increase in any complication (OR, 6.25; 95% CI, 1.24, 31.40). Operative time >174minutes was an independent predictor for development of a major local complication (OR, 4.05; 95% CI, 1.45, 11.30). Obesity was not associated with any specified complication after controlling for other variables. Conclusions: Whereas TSA has low short-term rates of perioperative complications and mortality, careful perioperative medical optimization and efficient surgical technique should be emphasized to decrease morbidity and mortality.

Original languageEnglish
Pages (from-to)24-30
Number of pages7
JournalJournal of Shoulder and Elbow Surgery
Issue number1
StatePublished - 2015
Externally publishedYes


  • Complications
  • Incidence rate
  • Mortality
  • Risk factors
  • Total shoulder arthroplasty


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