Abstract
Objectives
To provide clinicians and patients with accurate risk estimates of serious adverse events following common elective shoulder arthroscopic procedures including reoperation within 12 months.
Design
Population based cohort study.
Setting
Hospital Episode Statistics for NHS England including Civil Registration mortality data from the Office for National Statistics.
Participants
288 250 arthroscopic shoulder procedures performed in 261 248 adults (≥16 years) between 1st April 2009 and 31st March 2017. Elective arthroscopic shoulder procedures were grouped into subacromial decompression (ASAD), rotator cuff repair, acromioclavicular (AC) joint excision, glenohumeral stabilisation and frozen shoulder release.
Main outcome measures
Rates of serious adverse events at 90 days post-surgery, and rates of reoperation including deep surgical site infection at 1 year. The primary outcomes were mortality, pulmonary embolism (PE), lower respiratory tract infection, myocardial infarction, acute kidney injury, cerebrovascular accident and urinary tract infection requiring inpatient treatment within 90 days.
Results
288 250 arthroscopic shoulder procedures were performed in 261 248 adults during the study period. A progressive temporal increase in procedure numbers was observed except for ASAD which is now decreasing. The overall 90-day complication rate (including re-operation) was 1.23% (95% CI 1.19 to 1.27). This varied according to the procedure from 0.64% (0.54 to 0.76) following glenohumeral stabilisation, to 1.65% (1.48 to 1.83) following frozen shoulder release. After adjustment for age, comorbidity profile and gender, there was no effect of procedure type. The most common adverse event was lower respiratory tract infection (pneumonia), 0.33% (0.31 to 0.35). Pulmonary embolic events were rare (0.07%). At 12 months, the overall re-operation rate was 3.82% (3.75 to 3.90), ranging from 2.73% (2.50 to 2.98) following glenohumeral stabilisation, to 5.71% (5.37 to 6.07) following frozen shoulder release. The overall rate of further surgery for deep infection was low at 0.09% (0.08 to 0.10) but was higher following rotator cuff repair (0.19%, 0.16 to 0.23).
Conclusions
The risks associated with undergoing common shoulder arthroscopy procedures were low. Overall, the complication rate was 1 in 81, but ranged from 1 in 156 to 1 in 61. One in 26 patients underwent re-operation within 12 months. Nevertheless, serious complications do occur and whilst a temporal drop in ASAD numbers was observed, the numbers of other arthroscopic shoulder procedures continues to increase. This study provides overdue accurate estimates of the risks associated with these common procedures and will better inform patient decision making and consent.
Study registration
clinicaltrials.gov: NCT03573765
To provide clinicians and patients with accurate risk estimates of serious adverse events following common elective shoulder arthroscopic procedures including reoperation within 12 months.
Design
Population based cohort study.
Setting
Hospital Episode Statistics for NHS England including Civil Registration mortality data from the Office for National Statistics.
Participants
288 250 arthroscopic shoulder procedures performed in 261 248 adults (≥16 years) between 1st April 2009 and 31st March 2017. Elective arthroscopic shoulder procedures were grouped into subacromial decompression (ASAD), rotator cuff repair, acromioclavicular (AC) joint excision, glenohumeral stabilisation and frozen shoulder release.
Main outcome measures
Rates of serious adverse events at 90 days post-surgery, and rates of reoperation including deep surgical site infection at 1 year. The primary outcomes were mortality, pulmonary embolism (PE), lower respiratory tract infection, myocardial infarction, acute kidney injury, cerebrovascular accident and urinary tract infection requiring inpatient treatment within 90 days.
Results
288 250 arthroscopic shoulder procedures were performed in 261 248 adults during the study period. A progressive temporal increase in procedure numbers was observed except for ASAD which is now decreasing. The overall 90-day complication rate (including re-operation) was 1.23% (95% CI 1.19 to 1.27). This varied according to the procedure from 0.64% (0.54 to 0.76) following glenohumeral stabilisation, to 1.65% (1.48 to 1.83) following frozen shoulder release. After adjustment for age, comorbidity profile and gender, there was no effect of procedure type. The most common adverse event was lower respiratory tract infection (pneumonia), 0.33% (0.31 to 0.35). Pulmonary embolic events were rare (0.07%). At 12 months, the overall re-operation rate was 3.82% (3.75 to 3.90), ranging from 2.73% (2.50 to 2.98) following glenohumeral stabilisation, to 5.71% (5.37 to 6.07) following frozen shoulder release. The overall rate of further surgery for deep infection was low at 0.09% (0.08 to 0.10) but was higher following rotator cuff repair (0.19%, 0.16 to 0.23).
Conclusions
The risks associated with undergoing common shoulder arthroscopy procedures were low. Overall, the complication rate was 1 in 81, but ranged from 1 in 156 to 1 in 61. One in 26 patients underwent re-operation within 12 months. Nevertheless, serious complications do occur and whilst a temporal drop in ASAD numbers was observed, the numbers of other arthroscopic shoulder procedures continues to increase. This study provides overdue accurate estimates of the risks associated with these common procedures and will better inform patient decision making and consent.
Study registration
clinicaltrials.gov: NCT03573765
| Original language | English |
|---|---|
| Number of pages | 9 |
| Journal | BMJ |
| DOIs | |
| Publication status | Published - 6 Jul 2022 |