Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Risk factors for unexpected readmission and reoperation following open procedures for shoulder instability: a national database study of 1,942 cases

  • John M. Tarazi (Donald and Barbara Zucker School of Medicine at Hofstra/Northwell) ;
  • Matthew J. Partan (Donald and Barbara Zucker School of Medicine at Hofstra/Northwell) ;
  • Alton Daley (Touro College of Osteopathic Medicine) ;
  • Brandon Klein (Donald and Barbara Zucker School of Medicine at Hofstra/Northwell) ;
  • Luke Bartlett (Donald and Barbara Zucker School of Medicine at Hofstra/Northwell) ;
  • Randy M. Cohn (Donald and Barbara Zucker School of Medicine at Hofstra/Northwell)
  • Received : 2023.03.02
  • Accepted : 2023.05.23
  • Published : 2023.09.01
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Abstract

Background: The purpose of this study was to identify demographics and risk factors associated with unplanned 30-day readmission and reoperation following open procedures for shoulder instability and examine recent trends in open shoulder instability procedures. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried using current procedural terminology (CPT) codes 23455, 23460, and 23462 to find patients who underwent shoulder instability surgery from 2015 to 2019. Independent sample Student t-tests and chi-square tests were used in univariate analyses to identify demographic, lifestyle, and perioperative variables related to 30-day readmission following repair for shoulder instability. Multivariate logistic regression modeling was subsequently performed. Results: In total, 1,942 cases of open surgical procedures for shoulder instability were identified. Within our study sample, 1.27% of patients were readmitted within 30 days of surgery, and 0.85% required reoperation. Multivariate logistic regression modeling confirmed that the following patient variables were associated with a statistically significant increase in the odds of readmission: open anterior bone block/Latarjet-Bristow procedure, being a current smoker, and a long hospital stay (all P<0.05). Multivariate logistic regression modeling confirmed statistically significant increased odds of reoperation with an open anterior bone block or Latarjet-Bristow procedure (P<0.05). Conclusions: Unplanned 30-day readmission and reoperation after open shoulder instability surgery is infrequent. Patients who are current smokers, have an open anterior bone block or Latarjet-Bristow procedure, or a longer than average hospital stay have higher odds of readmission than others. Patients who undergo an open anterior bone block or Latarjet-Bristow procedure have higher odds of reoperation than those who undergo an open soft-tissue procedure. Level of evidence: III.

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References

  1. Shields DW, Jefferies JG, Brooksbank AJ, Millar N, Jenkins PJ. Epidemiology of glenohumeral dislocation and subsequent instability in an urban population. J Shoulder Elbow Surg 2018;27:189-95. 
  2. Rosa JR, Checchia CS, Miyazaki AN. Traumatic anterior instability of the shoulder. Rev Bras Ortop 2017;52:513-20. 
  3. Galvin JW, Ernat JJ, Waterman BR, Stadecker MJ, Parada SA. The epidemiology and natural history of anterior shoulder instability. Curr Rev Musculoskelet Med 2017;10:411-24. 
  4. Provencher MT, Bhatia S, Ghodadra NS, et al. Recurrent shoulder instability: current concepts for evaluation and management of glenoid bone loss. J Bone Joint Surg Am 2010;92 Suppl 2:133-51. 
  5. Wasserstein DN, Sheth U, Colbenson K, et al. The true recurrence rate and factors predicting recurrent instability after nonsurgical management of traumatic primary anterior shoulder dislocation: a systematic review. Arthroscopy 2016;32:2616-25. 
  6. Arciero RA, Wheeler JH, Ryan JB, McBride JT. Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med 1994;22:589-94. 
  7. Bottoni CR, Wilckens JH, DeBerardino TM, et al. A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations. Am J Sports Med 2002;30:576-80. 
  8. Wheeler JH, Ryan JB, Arciero RA, Molinari RN. Arthroscopic versus nonoperative treatment of acute shoulder dislocations in young athletes. Arthroscopy 1989;5:213-7. 
  9. Dora C, Gerber C. Shoulder function after arthroscopic anterior stabilization of the glenohumeral joint using an absorbable tac. J Shoulder Elbow Surg 2000;9:294-8. 
  10. Schroder DT, Provencher MT, Mologne TS, Muldoon MP, Cox JS. The modified Bristow procedure for anterior shoulder instability: 26-year outcomes in Naval Academy midshipmen. Am J Sports Med 2006;34:778-86. 
  11. Bokshan SL, DeFroda SF, Owens BD. Comparison of 30-day morbidity and mortality after arthroscopic bankart, open bankart, and latarjet-bristow procedures: a review of 2864 cases. Orthop J Sports Med 2017;5:2325967117713163. 
  12. Goodloe JB, Traven SA, Johnson CA, Woolf SK, Nutting JT, Slone HS. Increased risk of short-term complications and venous thromboembolism in Latarjet-Bristow procedures compared with bankart repairs. Arthroscopy 2021;37:806-13. 
  13. Olds MK, Ellis R, Parmar P, Kersten P. Who will redislocate his/her shoulder? Predicting recurrent instability following a first traumatic anterior shoulder dislocation. BMJ Open Sport Exerc Med 2019;5:e000447. 
  14. Eberlin CT, Varady NH, Kucharik MP, Naessig SA, Best MJ, Martin SD. Comparison of perioperative complications following surgical treatment of shoulder instability. JSES Int 2022;6:355-61. 
  15. Martin CT, Gao Y, Pugely AJ, Wolf BR. 30-Day morbidity and mortality after elective shoulder arthroscopy: a review of 9410 cases. J Shoulder Elbow Surg 2013;22:1667-75. 
  16. Martin CT, Pugely AJ, Gao Y, Wolf BR. Risk factors for thirty-day morbidity and mortality following knee arthroscopy: a review of 12,271 patients from the national surgical quality improvement program database. J Bone Joint Surg Am 2013;95:e98. 
  17. Shields E, Thirukumaran C, Thorsness R, Noyes K, Voloshin I. An analysis of adult patient risk factors and complications within 30 days after arthroscopic shoulder surgery. Arthroscopy 2015;31:807-15. 
  18. Waterman BR, Dunn JC, Bader J, Urrea L, Schoenfeld AJ, Belmont PJ Jr. Thirty-day morbidity and mortality after elective total shoulder arthroplasty: patient-based and surgical risk factors. J Shoulder Elbow Surg 2015;24:24-30.