The Effect of Operative Time on Postoperative Outcomes in Total Shoulder Arthroplasty

We hypothesized that increased operative time, as measured in 20-minute intervals, would be significantly associated with increased complications following TSA. Total shoulder arthroplasty (TSA) has been demonstrated to be an effective treatment for arthritis of the glenohumeral joint. Prior studies have identified longer operative times as a risk factor for complications after numerous types of procedures. Patients undergoing TSA from 2006-2015 were identified using Current Procedural Terminology (CPT) codes from the ACS-NSQIP database. Patient demographic information, perioperative parameters, and 30-day postoperative complications were retrieved. The Pearson’s chi-square test and a multivariate Poisson regression with robust error variance were used to analyze the relationship of operative time and postoperative complications. 10,082 patients undergoing TSA were identified. The average patient was 69.15 years old (Range 23-89) and was overweight (mean body mass index [BMI] = 31.21). Multivariate analysis revealed that for each increase in 20 minutes (17.5% of mean operative time) of operative time, there were significantly increased rates of any complication (relative risk [RR] 1.24, 95% confidence interval [CI] 1.19-1.26), anemia requiring transfusion (RR 1.33, 95% CI 1.26-1.4), peripheral nerve injury (RR 1.88, 95% CI 1.53-2.31), and urinary tract infection (RR 1.24, 95% CI 1.09-1.41). The findings of this study indicated that increasing operative time by an interval of 20 minutes confers significantly increased risk for postoperative complications following TSA. We anticipate the results of this manuscript will be used for provider education, policy decision-making, and potentially to derive algorithms that can improve safety and efficiency after shoulder arthroplasty.