Cardiopulmonary complications after primary shoulder arthroplasty: a cohort study

To study the frequency and predictors of 90-day cardiopulmonary complications following primary shoulder arthroplasty.

We used prospectively collected data from the Mayo Clinic Total Joint registry from 1976 to 2008. We used univariate and multivariable-adjusted Cox regression analyses to examine the association of age, gender, body mass index, comorbidity assessed by Deyo-Charlson index, American Society of Anesthesiologist class, implant fixation (cemented versus not), and underlying diagnosis with the risk of 90-day cardiopulmonary complications after primary shoulder arthroplasty. Odds ratio (OR) with 95% confidence interval (CI) and P values are presented.

A total of 3480 patients underwent 4019 primary shoulder arthroplasties. Ninety-day cardiac and thromboembolic complication rates following primary shoulder arthroplasty were 2.6% (92/3480) and 1.2% (42/3480). After multivariable-adjustment, age >70 years (OR, 2.7; 95% CI: 1.2-5.9; P value = 0.01; relative to age <60), Deyo-Charlson comorbidity index of 1 or more (OR, 3.27; 95% CI:1.9-5.6; P < 0.0001; relative to index of 0), and prior cardiac events (OR, 7.87; 95% CI: 4.89-12.68; P < 0.0001; relative to no prior event) were associated with higher odds of 90-day cardiac complications. Due to a few thromboembolic events, only univariate analyses were performed. Univariately, female gender, age >70 years, body mass index 25 to 29.9 kg/m(2), Deyo Charlson index of 1 or more, underlying diagnosis of trauma, prior thromboembolic event, and surgery type were each associated with significantly higher risk of 90-day thromboembolic event (P ≤ 0.03 for all).

Cardiac and thromboembolic complications are uncommon after primary shoulder arthroplasty. Patients can be informed of their risk of cardiac complications following shoulder arthroplasty based on the presence of risk factors.