UC Irvine

Background:

As the incidence of shoulder arthroplasty continues to increase, the number of patients with chronic obstructive pulmonary disease (COPD) undergoing shoulder arthroplasty also increases. COPD has been shown to be a significant risk factor in general surgery, total hip arthroplasty and total knee arthroplasty, where it is associated with an increase in complication rates and mortality after surgery.

Methods:

This was a retrospective administrative database study using the National Inpatient Sample (NIS) from 2001 to 2014. Patients undergoing shoulder arthroplasty were identified using ICD-9-CM procedural codes and split into two groups: patients with COPD and without COPD. Trends of patients undergoing shoulder arthroplasty across the years were determined. Univariate statistical analysis was used to compare demographics, comorbidity and complication rates. Multivariate regression was used to determine the independent risk that COPD contributes to complications. Inpatient cost and length of stay were also compared between groups.

Results:

The incidence of shoulder arthroplasty has increased by 294% between 2001-2014. The number of patients with COPD has also increased, with 324% growth. COPD patients had significantly higher rates of comorbidities, especially congestive heart failure (COPD: 10.42% vs. non-COPD: 3.41%; p < .001) and depression (COPD: 16.75% vs. non-COPD: 11.63%; p < .001). They also had higher rates of post-operative complications, particularly respiratory complications (COPD: 5.70% vs. non-COPD: 1.25%; adjusted OR = 3.51; p < .001), overall complications (COPD: 10.48% vs. 4.37%; adjusted OR = 1.98; p < .001) and higher risk of mortality (COPD: 0.31% vs. non-COPD: 0.13%.; adjusted OR = 1.59; p < .001).

Discussion:

Shoulder arthroplasty in COPD patients is continuing to grow rapidly. COPD patients tend to have greater comorbidity burdens, higher rates of post-operative complications (especially respiratory complications) and increased mortality. Improved pre-surgical optimization and increased attention to post-operative management is necessary to improve outcomes of patients with COPD undergoing shoulder arthroplasty.