Comparison of 30-Day Morbidity and Mortality After Arthroscopic Bankart, Open Bankart, and Latarjet-Bristow Procedures: A Review of 2864 Cases

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Abstract

Background:

Surgical intervention for anterior shoulder instability is commonly performed and is highly successful in reducing instances of recurrent instability.

Purpose:

To determine and compare the incidence of 30-day complications and patient and surgical risk factors for complications for arthroscopic Bankart, open Bankart, and Latarjet-Bristow procedures.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

All arthroscopic Bankart, open Bankart, and Latarjet-Bristow procedures from 2005 to 2014 from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) prospective database were analyzed. Baseline patient variables were assessed, including the Charlson Comorbidity Index (CCI). Outcomes measures included length of operation, length of hospital stay, need for hospital admission, 30-day readmission, and 30-day return to the operating room. Binary logistic regression was performed for the presence of any complications after all 3 procedures.

Results:

There were 2864 surgical procedures (410 open Bankart, 163 Latarjet-Bristow, and 2291 arthroscopic Bankart) included. There was no significant difference with regard to age ( P = .11), body mass index ( P = .17), American Society of Anesthesiologists class ( P = .423), or CCI ( P = .479) for each group. The Latarjet-Bristow procedure had the highest overall complication rate (5.5%) compared with open (1.0%) and arthroscopic (0.6%) Bankart repairs. The Latarjet-Bristow procedure had significantly longer mean operative times ( P < .001) in addition to the highest 30-day return rate to the operating room (4.3%; 95% confidence interval, 1.2%-7.4%). Smoking status was an independent predictor of a postoperative complication ( P = .05; odds ratio, 8.0) after Latarjet-Bristow.

Conclusion:

Surgical intervention for anterior shoulder instability has a low rate of complication (arthroscopic Bankart, 0.6%; open Bankart, 1.0%; Latarjet-Bristow, 5.5%) in the early postoperative period, with the most common being surgical site infection, deep vein thrombosis, and return to the operating room.

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Most cited references 37

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Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

Yngve Falck-Ytter, Charles Francis, Norman A Johanson … (2012)

VTE is a serious, but decreasing complication following major orthopedic surgery. This guideline focuses on optimal prophylaxis to reduce postoperative pulmonary embolism and DVT. The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. In patients undergoing major orthopedic surgery, we recommend the use of one of the following rather than no antithrombotic prophylaxis: low-molecular-weight heparin; fondaparinux; dabigatran, apixaban, rivaroxaban (total hip arthroplasty or total knee arthroplasty but not hip fracture surgery); low-dose unfractionated heparin; adjusted-dose vitamin K antagonist; aspirin (all Grade 1B); or an intermittent pneumatic compression device (IPCD) (Grade 1C) for a minimum of 10 to 14 days. We suggest the use of low-molecular-weight heparin in preference to the other agents we have recommended as alternatives (Grade 2C/2B), and in patients receiving pharmacologic prophylaxis, we suggest adding an IPCD during the hospital stay (Grade 2C). We suggest extending thromboprophylaxis for up to 35 days (Grade 2B). In patients at increased bleeding risk, we suggest an IPCD or no prophylaxis (Grade 2C). In patients who decline injections, we recommend using apixaban or dabigatran (all Grade 1B). We suggest against using inferior vena cava filter placement for primary prevention in patients with contraindications to both pharmacologic and mechanical thromboprophylaxis (Grade 2C). We recommend against Doppler (or duplex) ultrasonography screening before hospital discharge (Grade 1B). For patients with isolated lower-extremity injuries requiring leg immobilization, we suggest no thromboprophylaxis (Grade 2B). For patients undergoing knee arthroscopy without a history of VTE, we suggest no thromboprophylaxis (Grade 2B). Optimal strategies for thromboprophylaxis after major orthopedic surgery include pharmacologic and mechanical approaches.

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The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation.

F Balg, P. Boileau (2007)

There is no simple method available to identify patients who will develop recurrent instability after an arthroscopic Bankart procedure and who would be better served by an open operation. We carried out a prospective case-control study of 131 consecutive unselected patients with recurrent anterior shoulder instability who underwent this procedure using suture anchors. At follow-up after a mean of 31.2 months (24 to 52) 19 (14.5%) had recurrent instability. The following risk factors were identified: patient age under 20 years at the time of surgery; involvement in competitive or contact sports or those involving forced overhead activity; shoulder hyperlaxity; a Hill-Sachs lesion present on an anteroposterior radiograph of the shoulder in external rotation and/or loss of the sclerotic inferior glenoid contour. These factors were integrated in a 10-point pre-operative instability severity index score and tested retrospectively on the same population. Patients with a score over 6 points had an unacceptable recurrence risk of 70% (p < 0.001). On this basis we believe that an arthroscopic Bankart repair is contraindicated in these patients, to whom we now suggest a Bristow-Latarjet procedure instead.

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Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from "engaging/non-engaging" lesion to "on-track/off-track" lesion.

Giovanni Di Giacomo, Eiji Itoi, Stephen S Burkhart (2014)

For anterior instability with glenoid bone loss comprising 25% or more of the inferior glenoid diameter (inverted-pear glenoid), the consensus of recent authors is that glenoid bone grafting should be performed. Although the engaging Hill-Sachs lesion has been recognized as a risk factor for recurrent anterior instability, there has been no generally accepted method for quantifying the Hill-Sachs lesion and then integrating that quantification into treatment recommendations, taking into account the geometric interplay of various sizes and various orientations of bipolar (humeral-sided plus glenoid-sided) bone loss. We have developed a method (both radiographic and arthroscopic) that uses the concept of the glenoid track to determine whether a Hill-Sachs lesion will engage the anterior glenoid rim, whether or not there is concomitant anterior glenoid bone loss. If the Hill-Sachs lesion engages, it is called an "off-track" Hill-Sachs lesion; if it does not engage, it is an "on-track" lesion. On the basis of our quantitative method, we have developed a treatment paradigm with specific surgical criteria for all patients with anterior instability, both with and without bipolar bone loss.

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Author and article information

Journal

Journal ID (nlm-ta): Orthop J Sports Med

Journal ID (iso-abbrev): Orthop J Sports Med

Journal ID (publisher-id): OJS

Journal ID (hwp): spojs

Title: Orthopaedic Journal of Sports Medicine

Publisher: SAGE Publications (Sage CA: Los Angeles, CA )

ISSN (Electronic): 2325-9671

Publication date (Electronic): 03 July 2017

Publication date Collection: July 2017

Volume: 5

Issue: 7

Electronic Location Identifier: 2325967117713163

Affiliations

[* ]Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.

[† ]Department of Sports Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.

[3-2325967117713163] Investigation performed at Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA

Author notes

[*] [‡ ]Brett D. Owens, MD, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, 100 Butler Drive, Providence, RI 02906, USA (email: owensbrett@ 123456gmail.com ).

Article

Publisher ID: 10.1177_2325967117713163

DOI: 10.1177/2325967117713163

PMC ID: 5518960

PubMed ID: 28781973

SO-VID: 818789fc-6d4b-47be-ab32-bb6c225abdf4

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License ( http://www.creativecommons.org/licenses/by-nc-nd/3.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

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Keywords: shoulder instability,bankart repair,latarjet-bristow repair,national surgical quality improvement program,complication

Data availability:

Keywords: shoulder instability, bankart repair, latarjet-bristow repair, national surgical quality improvement program, complication