Perioperative complications after hemiarthroplasty and total shoulder arthroplasty are equivalent

Total shoulder arthroplasty (TSA) results in superior clinical outcomes to hemiarthroplasty (HA); however, TSA is a more technical and invasive procedure. This study retrospectively compares perioperative complications after HA and TSA using the National Surgical Quality Improvement Program (NSQIP) database. Methods: The NSQIP user file was queried for HA and TSA cases from the years 2005 through 2010. Major complications were defined as life-threatening or debilitating. All complications occurred within 30days of the initial procedure. We performed multivariate analysis to compare complication rates between the two procedures, controlling for patient comorbidities. Results: The database returned 1,718 patients (HA in 30.4% [n=523] and TSA in 69.6% [n=1,195]). The major complication rates in the HA group (5.2%, n=29) and TSA group (5.1%, n=61) were similar (P=.706). Rates of blood transfusions for postoperative bleeding in patients undergoing HA (2.3%, n=12) and TSA (2.9%, n=35) were indistinguishable (P=.458). Venous thromboembolism was a rare complication, occurring in 0.4% of patients in each group (2 HA patients and 5 TSA patients, P>.999). On multivariate analysis, the operative procedure was not associated with major complications (P=.349); however, emergency case, pulmonary comorbidity, anemia with a hematocrit level lower than 36%, and wound class of III or IV increased the risk of a major complication (P<.05 for all). Conclusion: Multivariate analysis of patients undergoing TSA or HA in the NSQIP database suggests that patient factors-not the procedure being performed-are significant predictors of major complications. Controlling for patient comorbidities, we found no increased risk of perioperative major complications in patients undergoing TSA compared with HA.