Factors associated with in-hospital death within 30 days after shoulder arthroplasty: a retrospective analysis

By 2040, the annual number of total shoulder arthroplasty (TSA) cases in the US, including both anatomic and reverse TSA, is predicted to reach almost 220,000. The most serious risk of TSA is death. In this study, we evaluated the incidence of in-hospital death within 30 days after TSA and factors associated with such deaths.

We retrospectively analyzed data from the National Surgical Quality Improvement Program (NSQIP) database from 2006 to 2022. We extracted data from inpatient records of patients aged 18 or older who underwent primary anatomical or reverse TSA for any indication. Temporal trends for the annual rates of in-hospital death were evaluated using curvilinear regression. A standard multivariable analysis, considering demographic factors and comorbidities identified through univariate analysis, analyzed the relationships between these variables and the likelihood of 30-day in-hospital death.

Of 34,953 cases, 64 (0.20%) in-hospital deaths occurred within 30 days after TSA, for a mean of 4.3 TSA-related deaths per year from 2008 to 2022. (No deaths were recorded in NSQIP from 2006 to 2007.) On average, patients who died were older, had a lower body mass index value, and were more likely to have heart failure, diabetes, and immunosuppressive therapy for chronic conditions than patients who did not die in the hospital within 30 days (all P <0.01).

We found several patient characteristics to be associated with a higher likelihood of death within 30 days after TSA. Orthopaedic surgeons are encouraged to identify patients with these characteristics to better counsel them when considering TSA.