No age cutoff accurately prognosticates the likelihood of 30-day medical complications, unplanned readmissions, and death after elective primary total shoulder arthroplasty

Background

Many surgeons and practices have adopted age cutoffs for performing total shoulder arthroplasty (TSA). The purpose of this study was to determine whether there exists an age cutoff of increased risk for 30-day medical complications, unplanned readmissions, and death after elective TSA.

Methods

The American College of Surgeons National Surgical Quality Improvement Project database was queried to identify patients aged 40-89 who underwent elective primary TSA from 2012 to 2020. Receiver operator curve analysis was used to attempt to identify a threshold in age that discriminated likelihood of a 30-day postoperative medical complications, unplanned readmissions, or death. The area under the curve (AUC) and the Matthews Correlation Coefficient (MCC) were determined for each model to identify their predictive value (AUC of 0.5 and MCC of 0 reflect no better than chance). Analyses were performed on the overall cohort and subcohorts stratified by sex, body mass index, and 5-item modified frailty index (mFI-5).

Results

We included 31,741 patients (56% female) that underwent elective primary TSA. 21% of patients had an mFI-5 of ≥2. The rate of 30-day postoperative medical complications, unplanned readmissions, and death was 6.3%, with unplanned readmissions (2.8%), intraoperative or postoperative transfusions (2.1%), and urinary tract infections (0.7%) being the most common complications. The AUC and MCC for the 30-day medical complications in the overall cohort (age threshold: 74-years old) were 0.59 and 0.08, respectively, reflecting poor predictive value. After stratifying based on sex, body mass index, and mFI-5, the highest AUC and MCC values obtained were 0.62 and 0.14, reflecting poor predictive value.

Conclusion

Age cutoffs poorly predict the risk of 30-day medical complications, unplanned readmissions, or death after elective TSA. Rather than a strict age cutoff, surgeons should consider multivariable risk stratification tools and clinical acumen to identify patients at risk for early postoperative medical complications.