Increased mortality after anterior shoulder dislocation: 255 patients aged 12-40 years followed for 25 years

Abstract

Background: No data exist regarding mortality rate in young patients with a first-time anterior shoulder dislocation. A cohort of 255 patients aged 12-40 years had a primary anterior shoulder dislocation during the years 1978 and 1979. After 10 years, 9 of the patients had died--which is a high figure for this cohort of patients. The question thus arose as to whether these patients had an increased mortality rate. In this study we have examined the mortality rate in these patients 25 years after the primary dislocation, relative to that of the Swedish population in general.

Patients and methods: In 1978 and 1979, 255 patients aged 12-40 years (257 shoulders) with first-time anterior shoulder dislocation were treated with or without immobilization. During 2003 and 2004, a follow-up of all patients who were alive was undertaken and the certificates of causes of death of 27 deceased patients were also analyzed.

Results: The mortality rate (SMR) for the patients in this study was more than double that of the general Swedish population (p<0.001). A higher proportion of the deceased patients had etiology other than sports-related activity as a cause of their initial dislocation (p=0.04). 11 of the 27 who were deceased had died from injury or intoxication (S00-T98, ICD10), which was more than expected relative to the causes of death for the general Swedish population in 2003 and 2004 (p<0.001)

Interpretation: The doubled mortality rate in our cohort of patients is most probably explained by the inclusion of a disproportionate number of patients with alcoholic behavior, which may affect the long-term outcome in trauma series.