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Liu SH, Bramian A, Loyst RA, Kashanchi K, Wang ED. The association of hyponatremia and early postoperative complications in aseptic revision total shoulder arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3251-3257. [PMID: 39133255 PMCID: PMC11377477 DOI: 10.1007/s00590-024-04054-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 07/31/2024] [Indexed: 08/13/2024]
Abstract
PURPOSE This study investigates the association between preoperative serum sodium levels and 30-day postoperative complications following aseptic revision total shoulder arthroplasty (TSA). METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent aseptic revision TSA from 2015 to 2022. The study population was divided into two groups based on preoperative serum sodium levels: eunatremia (135-144 mEq/L) and hyponatremia (< 135 mEq/L). Logistic regression analysis was performed to investigate the relationship between hyponatremia and early postoperative complications. RESULTS Compared to eunatremia, hyponatremia was independently associated with a significantly greater likelihood of experiencing any complication (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.14-2.40; P = .008), blood transfusions (OR 2.45, 95% CI 1.24-4.83; P = .010), unplanned reoperation (OR 2.27, 95% CI 1.07-4.79; P = .032), and length of stay > 2 days (OR 1.63, 95% CI 1.09-2.45; P = .017). CONCLUSION Hyponatremia was associated with a greater rate of early postoperative complications following noninfectious revision TSA. This study sheds light on the role of preoperative hyponatremia as a risk factor for postoperative complications and may help surgeons better select surgical candidates and improve surgical outcomes in the setting of revision TSA.
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Affiliation(s)
- Steven H Liu
- Department of Orthopaedics, Keck Medicine of University of Southern California, 1540 Alcazar Street CHP 207, Los Angeles, CA, 90089-9007, USA.
| | - Allen Bramian
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - Rachel A Loyst
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - Kevin Kashanchi
- Department of Orthopaedics, Keck Medicine of University of Southern California, 1540 Alcazar Street CHP 207, Los Angeles, CA, 90089-9007, USA
| | - Edward D Wang
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
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Liu SH, Cerri-Droz P, Loyst RA, Komatsu DE, Wang ED. Hypoalbuminemia predicts early postoperative complications following noninfectious revision total shoulder arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3129-3134. [PMID: 38972926 PMCID: PMC11377516 DOI: 10.1007/s00590-024-04041-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/30/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE This study investigates the association between preoperative hypoalbuminemia and 30-day postoperative complications following noninfectious revision total shoulder arthroplasty (TSA). METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent noninfectious revision TSA from 2015 to 2021. The study population was divided into two groups based on preoperative serum albumin: normal albumin (≥ 3.5 g/dL) and hypoalbuminemia (< 3.5 g/dL). Logistic regression analysis was conducted to investigate the relationship between preoperative hypoalbuminemia and postoperative complications. RESULTS Compared to normal albumin, hypoalbuminemia was independently associated with a significantly greater likelihood of experiencing any complication (odds ratio [OR] 3.26, 95% confidence interval [CI] 2.04-5.19; P < .001), sepsis (OR 9.92, 95% CI 1.29-76.35; P = .028), blood transfusions (OR 2.89, 95% CI 1.20-6.93; P = .017), non-home discharge (OR 2.88, 95% CI 1.55-5.35; P < .001), readmission (OR 3.46, 95% CI 1.57-7.58; P = .002), and length of stay > 2 days (OR 3.00, 95% CI 1.85-4.86; P < .001). CONCLUSIONS Preoperative hypoalbuminemia was associated with early postoperative complications following revision TSA. LEVEL OF EVIDENCE Level III; Retrospective Cohort Comparison; Prognosis Study.
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Affiliation(s)
- Steven H Liu
- Department of Orthopaedics, Stony Brook University, HSC T-18, Room 080, Stony Brook, NY, 11794-8181, USA.
- Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, USA.
| | - Patricia Cerri-Droz
- Department of Orthopaedics, Stony Brook University, HSC T-18, Room 080, Stony Brook, NY, 11794-8181, USA
| | - Rachel A Loyst
- Department of Orthopaedics, Stony Brook University, HSC T-18, Room 080, Stony Brook, NY, 11794-8181, USA
| | - David E Komatsu
- Department of Orthopaedics, Stony Brook University, HSC T-18, Room 080, Stony Brook, NY, 11794-8181, USA
| | - Edward D Wang
- Department of Orthopaedics, Stony Brook University, HSC T-18, Room 080, Stony Brook, NY, 11794-8181, USA
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Grovu R, Quan T, Wei C, Das A, Nguyen A, Tabaie S, Zimmer ZR. Worsening of anemia increases the risks of complications and prolonged length of stay following revision total shoulder arthroplasty. Shoulder Elbow 2024; 16:285-293. [PMID: 38818105 PMCID: PMC11135193 DOI: 10.1177/17585732231172162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/08/2023] [Accepted: 04/09/2023] [Indexed: 06/01/2024]
Abstract
Background There are no studies currently in the literature that assesses complications following revision total shoulder arthroplasty (TSA) in patients with varying severity of anemia. The purpose of this study was to determine the impact of preoperative anemia severity on postoperative complications following revision TSA. Methods Patients undergoing revision TSA from 2013 to 2019 were queried in a national database. Based on previous studies' definitions of anemia, three subgroups were stratified: patients without anemia (hematocrit >36% for women, hematocrit >39% for men), patients with mild anemia (hematocrit 33% to 36% for women, hematocrit 33% to 39% for men) and patients with moderate to severe anemia (hematocrit <33% for both women and men). In this analysis, patient demographics, comorbidities, and postoperative complications were compared between the three groups. Results Of 1559 total patients undergoing revision TSA, 1178 patients (75.6%) did not have anemia, 255 (16.3%) had mild anemia, and 126 (8.1%) had moderate/severe anemia. Following adjustment on multivariate analysis, patients with mild anemia were more likely to have postoperative transfusion and extended length of stay compared to non-anemic patients. Patients with moderate/severe anemia were at increased risk of postoperative transfusion, sepsis, extended length of stay, and reoperation compared to non-anemic patients. Discussion From mild anemia to moderate/severe anemia, there was a stepwise increase in the risk of postoperative complications. Our study showed that there is clinical value in the preoperative correction of anemia for these patients as it relates to complications and hospital stay. Level of Evidence III.
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Affiliation(s)
- Radu Grovu
- Staten Island University Hospital, Staten Island, NY, USA
| | - Theodore Quan
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Chapman Wei
- Staten Island University Hospital, Staten Island, NY, USA
| | - Avilash Das
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Sean Tabaie
- Department of Orthopaedic Surgery, Children's National Health System, Washington, DC, USA
| | - Zachary R Zimmer
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Liu SH, Leonardo CJ, Loyst RA, Cerri-Droz P, Lung B, Zhu A, Wang ED. Elevated alkaline phosphatase independently predicts early postoperative complications in noninfectious revision total shoulder arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2081-2087. [PMID: 38532125 DOI: 10.1007/s00590-024-03902-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE This study investigates the association between preoperative serum alkaline phosphatase levels and 30 day postoperative complications following noninfectious revision total shoulder arthroplasty (TSA). We hypothesize that elevated alkaline phosphatase levels are significantly associated with an increased 30 day postoperative complication rate. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent noninfectious revision TSA from 2015 to 2022. The study population was divided into two groups based on preoperative serum alkaline phosphatase: normal (44-147 IU/L) and elevated (> 147 IU/L). Logistic regression analysis was conducted to investigate the relationship between elevated alkaline phosphatase levels and postoperative complications. RESULTS Compared to normal levels, elevated alkaline phosphatase was independently associated with a significantly greater likelihood of experiencing any complications (odds ratio [OR] 2.54, 95% confidence interval [CI] 1.41-4.55; P = .002), sepsis (OR 9.96, 95% CI 1.67-59.29; P = .012), blood transfusions (OR 3.77, 95% CI 1.48-9.61; P = .005), readmission (OR 3.65, 95% CI 1.48-9.01; P = .005), and length of stay > 2 days (OR 2.37, 95% CI 1.31-4.30; P = .004). CONCLUSIONS Elevated preoperative alkaline phosphatase was associated with a greater rate of early postoperative complications following noninfectious revision TSA. LEVEL OF EVIDENCE Level III; Retrospective Cohort Comparison; Prognosis Study.
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Affiliation(s)
- Steven H Liu
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, 11794, USA.
| | | | - Rachel A Loyst
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Patricia Cerri-Droz
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Brandon Lung
- Department of Orthopaedics, University of California Irvine, Orange, CA, USA
| | - Andrew Zhu
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Edward D Wang
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, 11794, USA
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Stauffer TP, Goltz DE, Wickman JR, Levin JM, Lassiter TE, Anakwenze OA, Klifto CS. Trends in outcomes following aseptic revision shoulder arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3025-3031. [PMID: 36964819 DOI: 10.1007/s00590-023-03524-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/09/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE As the incidence of anatomic and reverse total shoulder arthroplasty (TSA, RSA) increases, revision procedures will also increase with a corresponding need for counseling patients regarding outcomes. We hypothesized that different revision categories would have different complication profiles depending on both the indication as well as the nature of the prior hardware. METHODS A retrospective review of 1773 cases performed at a single tertiary health system utilized case postings and diagnoses to identify revision shoulder arthroplasty cases. Revisions were classified based on the prior hardware present, with basic demographics and other perioperative and postoperative outcomes recorded within the limits of available follow-up. RESULTS 166 surgical cases involving revision of prior shoulder arthroplasty metal hardware were identified with an average follow-up of 1.0 years. Immediate perioperative outcomes of revision cases were similar relative to the companion cohort of 1607 primary cases. 137 cases (83%) required no further revision surgery, while 19 cases (11%) underwent aseptic revision, and 10 cases (6%) were revised for periprosthetic infection. RSA hardware revised to another RSA had the highest repeat revision rate relative to the other revision categories (32% vs < 14%). CONCLUSIONS Revision of reverse shoulder arthroplasty to a repeat reverse has the highest rate of subsequent all-cause revision, and these repeat revisions often occurred for periprosthetic infection. Despite a relatively high long-term complication rate following revision shoulder arthroplasty, immediate perioperative outcomes remain similar to primary cases, providing some preliminary evidence for policymakers considering inclusion in future value-based care models. LEVEL OF EVIDENCE Level III Treatment Study.
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Affiliation(s)
- Taylor P Stauffer
- School of Medicine, Duke University Hospital, Duke University, 40 Duke Medicine Circle, Durham, NC, 27710, USA.
| | - Daniel E Goltz
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA
| | - John R Wickman
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA
| | - Jay M Levin
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA
| | - Tally E Lassiter
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA
| | - Oke A Anakwenze
- Division of Orthopedic Surgery, Duke University, Durham, NC, USA
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Cox RM, Hendy BA, Gutman MJ, Sherman M, Abboud JA, Namdari S. Utilization of comorbidity indices to predict discharge destination and complications following total shoulder arthroplasty. Shoulder Elbow 2023; 15:274-282. [PMID: 37325391 PMCID: PMC10268142 DOI: 10.1177/17585732211049726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/11/2021] [Indexed: 09/20/2023]
Abstract
Background Comorbidity indices can help identify patients at risk for postoperative complications. Purpose of this study was to compare different comorbidity indices to predict discharge destination and complications after shoulder arthroplasty. Methods Retrospective review of institutional shoulder arthroplasty database of primary anatomic (TSA) and reverse (RSA) shoulder arthroplasties. Patient demographic information was collected in order to calculate Modified Frailty Index (mFI-5), Charlson Comorbidity Index (CCI), age adjusted CCI (age-CCI), and American Society of Anesthesiologists physical status classification system (ASA). Statistical analysis performed to analyze length of stay (LOS), discharge destination, and 90-day complications. Results There were 1365 patients included with 672 TSA and 693 RSA patients. RSA patients were older and had higher CCI, age adjusted CCI, ASA, and mFI-5 (p < 0.001). RSA patients had longer lengths of stay (LOS), more likely to have an adverse discharge (p < 0.001), and higher reoperation rate (p = 0.003). Age-CCI was most predictive of adverse discharge (AUC 0.721, 95% CI 0.704-0.768). Discussion Patients undergoing RSA had more medical comorbidities, experienced greater LOS, higher reoperation rate, and were more likely to have an adverse discharge. Age-CCI had the best ability to predict which patients were likely to require higher-level discharge planning.
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Affiliation(s)
- Ryan M. Cox
- Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Benjamin A. Hendy
- Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael J. Gutman
- Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Sherman
- Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph A. Abboud
- Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Surena Namdari
- Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Zhao H, Meng J, Sun T, Wan Z, Qin S, Zhang F, Hou Z. Risk factors for deep surgical site infection following surgically treated peri-ankle fractures: a case-control study based on propensity score matching. J Orthop Surg Res 2022; 17:542. [PMID: 36522748 PMCID: PMC9753310 DOI: 10.1186/s13018-022-03436-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
AIMS This study aims to identify the risk factors for deep surgical site infection (DSSI) following surgically treated peri-ankle fractures. METHODS We performed a retrospective case-control study using the propensity score matching (PSM) method in 1:2 ratio, based on the 6 baseline variables, including age, gender, living area, insurance type, fracture location and surgical date. Data on patients who underwent surgical treatment of peri-ankle fractures were collected by inquiring their hospitalization medical records and operative records, as well as the laboratory reports. Conditional logistic regression analysis was performed to identify the risk factors for DSSI. RESULTS A total of 2147 patients were eligibly included and 74 had a DSSI, indicating an incidence rate of 3.4%. After PSM, 70 cases of DSSI and 140 controls without DSSI were matched, constituting the study cohort. The univariate analyses showed significant differences between groups in terms of history of any surgery, time to operation, surgical wound classification, smoking, alcohol drinking, RBC count, hemoglobin concentration and hematocrit (%). The conditional logistic regression analysis showed time to operation of < 4 or > 9 (vs 4-9 days); unclean wound, current smoking, high-energy injury mechanism and lower hematocrit were independent risk factors for DSSI. CONCLUSIONS Timely modification of smoking and hematocrit (%), and limiting operation within a rational time frame for an optimized soft tissue condition, may provide potential clinical benefits for SSI prevention.
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Affiliation(s)
- Haitao Zhao
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Trauma Center, The 3rd Hospital of Hebei Medical University, No 139 Ziqiang Road, Shijiazhuang, 050051 Hebei People’s Republic of China ,grid.452209.80000 0004 1799 0194Department of Foot and Ankle Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Jinghong Meng
- grid.452209.80000 0004 1799 0194Department of Rheumatology and Immunology, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Tao Sun
- grid.452209.80000 0004 1799 0194Department of Bone Tumor, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Zihan Wan
- grid.256883.20000 0004 1760 8442College of Basic Medicine, Hebei Medical University, Shijiazhuang, 050000 Hebei People’s Republic of China
| | - Shiji Qin
- grid.452209.80000 0004 1799 0194Department of Foot and Ankle Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Fengqi Zhang
- grid.452209.80000 0004 1799 0194Department of Foot and Ankle Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Zhiyong Hou
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Trauma Center, The 3rd Hospital of Hebei Medical University, No 139 Ziqiang Road, Shijiazhuang, 050051 Hebei People’s Republic of China
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Seok HG, Park JJ, Park SG. Risk Factors for Periprosthetic Joint Infection after Shoulder Arthroplasty: Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11144245. [PMID: 35888008 PMCID: PMC9316575 DOI: 10.3390/jcm11144245] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 12/04/2022] Open
Abstract
Periprosthetic joint infection (PJI) after shoulder arthroplasty is a devastating complication that requires several additional surgeries. The purpose of this study was to assess the evidence regarding risk factors for PJI and identify those that contribute to infection by performing a meta-analysis. We searched the PubMed, Embase, and Cochrane Library databases for studies that assessed the risk factors for infection after shoulder arthroplasty. After performing screening and quality assessment on the articles, we obtained two case-control studies and six retrospective cohort studies (total of 420 infected cases and 28,464 controls). Review Manager 5.4 was used to assess the heterogeneity and odds ratio for 20 different factors that broadly included demographic factors, perioperative factors, and comorbidities. Factors that are markedly associated with PJI after shoulder arthroplasty were male sex, operation history, revision arthroplasty, acute trauma, and non-osteoarthritis as a preoperative diagnosis. Statistical analysis revealed that diabetes mellitus, liver disease, alcohol overuse, iron-deficiency anemia, and rheumatoid arthritis were risk factors for PJI after shoulder arthroplasty. The result of analysis shows that several specific factors can be targeted to prevent infections after shoulder arthroplasty. Surgeons should consider the risk factors and perform the appropriate management for patients.
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Increased severity of anemia is associated with postoperative complications following primary total shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:2393-2400. [PMID: 33600898 DOI: 10.1016/j.jse.2021.01.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/01/2021] [Accepted: 01/10/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anemia has been demonstrated as a modifiable risk factor for postoperative complications following various types of primary and revision total joint arthroplasties. However, at present, we are not aware of any studies assessing postoperative complications following total shoulder arthroplasty (TSA) in patients with varying severity of anemia. The purpose of this study was to determine the influence of preoperative anemia severity on 30-day postoperative complications following primary TSA. METHODS Adult patients undergoing primary TSA from 2012 to 2018 were identified in the National Surgical Quality Improvement Program database. Patients undergoing TSA were substratified into 3 cohorts: nonanemia (hematocrit >36% for women, >39% for men), mild anemia (hematocrit 33%-36% for women, 33%-39% for men), and moderate to severe anemia (hematocrit <33% for both women and men), based on World Health Organization definitions of anemia. In this analysis, 30-day wound, cardiac, pulmonary, renal, and thromboembolic complications, as well as sepsis, mortality, postoperative transfusion, extended length of stay, and reoperation were assessed. Bivariate analyses, including χ2 and analysis of variance, and multivariable logistical regression were performed. RESULTS Of 13,921 total patients undergoing TSA, 11,330 patients (81.4%) did not have anemia, 1934 (13.9%) had mild anemia, and 657 (4.7%) had moderate to severe anemia. Following adjustment, patients with mild anemia were more likely to have a postoperative blood transfusion (odds ratio [OR] 4.7, P < .001), extended length of stay (OR 1.7, P = .002), and reoperation (OR 1.5, P = .028). Patients with moderate to severe anemia were at increased risk of cardiac complications (OR 3.0, P = .012), pulmonary complications (OR 2.2, P = .015), postoperative blood transfusion (OR 23.8, P < .001), extended length of stay (OR 6.6, P < .001), reoperation (OR 2.2, P = .003), and death (OR 3.8, P = .034). CONCLUSION From mild anemia to moderate to severe anemia, there was a stepwise and approximately 2-fold increase in the odds of postoperative complications for patients undergoing primary TSA. Patients with moderate to severe anemia should be medically optimized before they undergo TSA.
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Mid-term results after revision total hip arthroplasty with custom-made acetabular implants in patients with Paprosky III acetabular bone loss. Arch Orthop Trauma Surg 2020; 140:263-273. [PMID: 31820093 DOI: 10.1007/s00402-019-03318-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Severe acetabular bone loss, both with or without pelvic discontinuity, remains a challenge in revision total hip arthroplasty (RTHA). The goal of our study was to evaluate the mid-term results for consecutive patients with Paprosky III acetabular bone loss with or without pelvic discontinuity who needed RTHA with custom-made acetabular implants and to compare the results to those of other studies. MATERIALS AND METHODS Sixty-eight (68) patients with severe acetabular bone loss (Paprosky Type IIIa and IIIb), who required RTHA, were included in our study. All prostheses were constructed on the basis of thin-layer computed tomography (CT) scans of the pelvis. The visual analogue scale (VAS), Harrison hip score (HHS), and clinical and radiographic follow-up assessments were used to evaluate the outcome. RESULTS The average follow-up time was 43 months (range 1-120 months). Implant survival at last follow-up was 75% (51 of 68). Kaplan-Meier survival analysis, with explantation as the endpoint, revealed survival rates of 82.7% (3 years) and 77% (5 years). Patients with revision of the acetabular component only had a significant higher survival rate (p 0.012). Overall revision rate was 36.7%. Reinfection rate was 34.4%. Complications included 15 (22%) periprosthetic joint infections (PJI), 7 dislocations (10.2%), and 2 aseptic loosenings (2.9%). Mean VAS at last follow-up was 1.45 compared to 3.2 preoperatively, while mean HHS improved from 21.1 points preoperatively to 61 at last follow-up. The change in both scores was thus significant (p < 0.001). CONCLUSION Defect reconstruction with custom-made modular acetabular implants can be a good, nevertheless expensive, treatment option with clinically and radiologically satisfying results in comparison to recent studies in the literature. Nevertheless, high postoperative complication rates, especially in terms of PJI, remain a challenge.
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