{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:43:55Z","timestamp":1787755435695,"version":"build-2784847793"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>To effectively counsel patients prior to shoulder arthroplasty, surgeons should understand the overall life trajectory and life expectancy of patients in the context of the patient\u2019s shoulder pathology and medical comorbidities. Such an understanding can influence both operative and nonoperative decision-making and implant choices. This study evaluated 5-year mortality following shoulder arthroplasty in patients \u226565 years old and identified associated risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We utilized Centers for Medicare &amp; Medicaid Services Fee-for-Service inpatient and outpatient claims data to investigate the 5-year mortality rate following shoulder arthroplasty procedures performed from 2014 to 2016. The impact of patient demographics, including fracture diagnosis, year fixed effects, and state fixed effects; patient comorbidities; and hospital-level characteristics on 5-year mortality rates were assessed with use of a Cox proportional hazards regression model. A p value of &lt;0.05 was considered significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 108,667 shoulder arthroplasty cases (96,104 nonfracture and 12,563 fracture) were examined. The cohort was 62.7% female and 5.8% non-White and had a mean age at surgery of 74.3 years. The mean 5-year mortality rate was 16.6% across all shoulder arthroplasty cases, 14.9% for nonfracture cases, and 29.9% for fracture cases. The trend toward higher mortality in the fracture group compared with the nonfracture group was sustained throughout the 5-year postoperative period, with a fracture diagnosis being associated with a hazard ratio of 1.63 for mortality (p &lt; 0.001). Medical comorbidities were associated with an increased risk of mortality, with liver disease bearing the highest hazard ratio (3.07; p &lt; 0.001), followed by chronic kidney disease (2.59; p &lt; 0.001), chronic obstructive pulmonary disease (1.92; p &lt; 0.001), and congestive heart failure (1.90; p &lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The mean 5-year mortality following shoulder arthroplasty was 16.6%. Patients with a fracture diagnosis had a significantly higher 5-year mortality risk (29.9%) than those with a nonfracture diagnosis (14.9%). Medical comorbidities had the greatest impact on mortality risk, with chronic liver and kidney disease being the most noteworthy. This novel longer-term data can help with patient education and risk stratification prior to undergoing shoulder replacement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.23.00133","type":"journal-article","created":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T14:12:07Z","timestamp":1714399927000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Five-Year Mortality Rates Following Elective Shoulder Arthroplasty and Shoulder Arthroplasty for Fracture in Patients Over Age 65"],"prefix":"10.2106","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7251-6503","authenticated-orcid":false,"given":"Adam Z.","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Panorama City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4180-6567","authenticated-orcid":false,"given":"Xiaoran","family":"Zhang","sequence":"additional","affiliation":[{"name":"Avant-garde Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erlyn","family":"Macarayan","sequence":"additional","affiliation":[{"name":"Avant-garde Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4401-2834","authenticated-orcid":false,"given":"Matthew J.","family":"Best","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8566-912X","authenticated-orcid":false,"given":"Catherine J.","family":"Fedorka","sequence":"additional","affiliation":[{"name":"Cooper Bone and Joint Institute, Camden, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5395-7306","authenticated-orcid":false,"given":"Derek A.","family":"Haas","sequence":"additional","affiliation":[{"name":"Avant-garde Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3729-9811","authenticated-orcid":false,"given":"April D.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Bone and Joint Institute, Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Jawa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan A.","family":"O\u2019Donnell","sequence":"additional","affiliation":[{"name":"Boston Shoulder Institute, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1229-9586","authenticated-orcid":false,"given":"Jason E.","family":"Simon","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric R.","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Momin","family":"Malik","sequence":"additional","affiliation":[{"name":"Avant-garde Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0487-201X","authenticated-orcid":false,"given":"Michael B.","family":"Gottschalk","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary F.","family":"Updegrove","sequence":"additional","affiliation":[{"name":"Bone and Joint Institute, Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2563-6318","authenticated-orcid":false,"given":"Jon J.P.","family":"Warner","sequence":"additional","affiliation":[{"name":"Boston Shoulder Institute, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2314-8855","authenticated-orcid":false,"given":"Uma","family":"Srikumaran","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3845-7220","authenticated-orcid":false,"given":"Joseph A.","family":"Abboud","sequence":"additional","affiliation":[{"name":"Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"and the Avant-garde Health and Codman Shoulder Society Value-Based Care Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,4]]},"reference":[{"issue":"3","key":"R1-20240801","first-page":"e20.00156","article-title":"Prevalence of Shoulder Arthroplasty in the United States and the Increasing Burden of Revision Shoulder Arthroplasty","volume":"6","author":"Farley","year":"2021","journal-title":"JB JS Open Access"},{"issue":"2","key":"R2-20240801","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.jor.2018.05.038","article-title":"Outpatient total shoulder arthroplasty: A cost-identification analysis","volume":"15","author":"Steinhaus","year":"2018","journal-title":"J 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