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Outcomes of Shoulder Surgery in the Sitting Position With Interscalene Nerve Block: A Single-Center Series
  1. Max Rohrbaugh, MD*,
  2. Michael L. Kentor, MD†,
  3. Steven L. Orebaugh, MD† and
  4. Brian Williams, MD, MBA*,‡
  1. *Department of Anesthesiology, University of Pittsburgh School of Medicine; †UPMC-Southside/Mercy Ambulatory Surgical Center; and ‡Veteran’s Administration Hospital, Pittsburgh, PA.
  1. Address correspondence to: Steven L. Orebaugh, MD, Anesthesia Division, UPMC-Southside/Mercy Ambulatory Surgical Center, 2000 Mary St, Pittsburgh, PA 15228 (e-mail: OrebaughSL{at}anes.upmc.edu).

Abstract

Background Several case reports have raised serious concerns about the safety of shoulder surgery in the beach-chair position, related to global cerebral hypoperfusion. We summarize our experiences with 15,014 cases of shoulder arthroscopy over an 11-year period. Our primary aim was to evaluate the incidence of intraoperative or immediate postoperative neurologic events and secondarily to relate other perioperative complications.

Methods We searched our online deidentified departmental quality improvement and patient safety database for adverse outcomes associated with arthroscopic shoulder surgery performed in the beach-chair position for the 11-year period between April 2001 and November 2011, as well as our hospital-system database and a statewide database. This was compared with the total number of such cases, available from our department billing database.

Results The total rate of adverse events was 0.37%. Neurologic abnormalities suggestive of acute cerebral ischemia or hemorrhage did not occur in the immediate perioperative period. One new neurologic deficit was reported, secondary to ischemic stroke, which occurred 24 hours after the surgery. The most frequent complications detected were unplanned return to care (0.067%), local anesthetic systemic toxicity (0.053%), and airway compromise requiring unplanned intubation (0.033%). Complications were infrequent and did not vary in incidence over the course of the study.

Conclusions This retrospective study suggests that intraoperative or immediate postoperative stroke is rare when surgery is conducted in beach-chair position in conjunction with regional anesthesia, propofol sedation, and spontaneous respiration via natural airway.

https://doi.org/10.1097/AAP.0b013e318277a2eb

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    Footnotes

    • Joseph M. Neal, MD, served as editor-in-chief for this article.

      Departmental resources were used for this investigation.

      Presented in abstract form at the American Society of Anesthesiologists’ annual meeting in Chicago, IL, October, 2011.

      Dr. Orebaugh receives royalties related to authorship from Lippincott Williams and Wilkins and from the Johns Hopkins University Press.

      The Pennsylvania Cost Care Containment Council (PHC4) is an independent state agency responsible for addressing the problem of escalating health costs, ensuring the quality of health care, and increasing access to health care for all citizens, regardless of ability to pay. PHC4 has provided data to the authors in an effort to further PHC4’s mission of educating the public on containing health care costs in Pennsylvania. PHC4, its agents and staff, have made no representation, guarantee, or warranty, express or implied, that the data—financial, patient, payor, and physician-specific information—provided to the authors are error-free or that the use of the data will avoid differences of opinion or interpretation. The analysis was not prepared by PHC4. This analysis was prepared by the authors. PHC4, its agents, and staff bear no responsibility or liability for the results of the analysis, which are solely the opinion of the authors.