30-day morbidity and mortality after elective shoulder arthroscopy: a review of 9410 cases

Abstract

Background: Few studies have reported incidence of or risk factors for morbidity and mortality after elective shoulder arthroscopy.

Methods: We used Current Procedural Terminology (CPT) billing codes to query the National Surgical Quality Improvement Program database and identified 9410 cases of elective shoulder arthroscopy. Univariate and multivariate analyses were used to identify risk factors for complication.

Results: Among 9410 patients, 109 complications occurred in 93 (0.99%). Major morbidity was 0.54% (51 patients), which included 4 patients (0.04%) with a mortality, and minor morbidity was 0.44% (42 patients). The most common complication was a return to the operating room (29 cases, 0.31%). Superficial surgical site infections occurred in 15 cases (0.16%), deep infections in 1 (0.01%), deep venous thrombosis or thrombophlebitis in 8 (0.09%), peripheral nerve injury in 1 (0.01%), and pulmonary embolism in 6 (0.06%). The multivariate analysis showed smoking history (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.12-3.27), history of chronic obstructive pulmonary disease (OR, 3.25; 94% CI, 1.38-7.66), operative time of longer than 1.5 hours (OR, 2.1; 95% CI, 1.32-3.36), and American Society of Anesthesia class of 3 or 4 compared with 1 or 2 (OR, 1.82; 95% CI, 1.03-3.21) as risk factors for complication.

Conclusions: Morbidity and mortality are rare events after elective shoulder arthroscopy, and the procedure should generally be considered safe. Surgeons should offer smoking cessation to active users of tobacco and should be efficient with operative time whenever possible.

Level of evidence: Level II, prospective cohort design, treatment study.

Keywords: Arthroscopy; Level II; Prospective Cohort Design; Treatment Study; complications; morbidity; mortality; risk factors; shoulder.