Background

By 2040, annual total shoulder arthroplasties (TSA) are projected to reach nearly 220,000 procedures. The most tragic outcome following TSA is mortality, making the procedure daunting for patients. This study evaluates 30-day inpatient mortality rates for TSAs and aims to identify key mortality risk factors.

Methods

We retrospectively analyzed the National Surgical Quality Improvement Program database from 2006 to 2022, focusing on inpatient records of individuals aged 18 and above who underwent primary TSA. Temporal trends in inpatient mortality rates were assessed using curvilinear regression analysis. A standard multivariable analysis examined the relationship between demographic factors, comorbidities, and 30-day inpatient mortality.

Results

The analysis included 34,953 TSAs, with 64 (0.20%) inpatient deaths occurring within 30 days of surgery. On average, 4.27 TSA-related deaths occurred annually from 2008 to 2022. Patients with 30-day inpatient mortality had a mean age of 74.7 years and a BMI of 28.6 kg/m². Multivariate analysis revealed that older age, lower BMI, heart failure, diabetes, and immunosuppressive therapy were significantly associated with inpatient mortality. Curvilinear regression analysis showed a U-shaped trend in mortality rates, with the lowest 30-day inpatient mortality in 2016. The quadratic regression model explained 83.9% of the variance in mortality rates.

Discussion

Patients experiencing 30-day inpatient mortality after TSA were older, had a lower BMI, and were more likely to have heart failure, diabetes, and be on immunosuppressive therapy. Orthopaedic surgeons should consider preoperative optimization for these high-risk patients to reduce mortality.