Modifiable Risk Factors for Complication Following Shoulder Arthroplasty: The Effect of Opioid Use, Corticosteroid Injections, and Previous Shoulder Surgery 公开

Farley, Kevin (Spring 2021)

Permanent URL: https://etd.library.emory.edu/concern/etds/dv13zv31n?locale=zh
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Abstract

Given an exponential increase in the utilization of primary total shoulder arthroplasty (TSA), there is an increased need for the surveillance of revision procedures and the identification of factors associated with poor postoperative outcomes. The aims of this study were to forecast the incidence and national cost of revision TSA and prosthetic joint infection (PJI) through the coming decade using the National Inpatient Sample. Subsequently, using the Truven Health MarketScan database, we aimed to identify several potentially modifiable risk factors as they relate to complication following TSA – particularly opioid use, corticosteroid injections, and a prior shoulder surgery. From 2008 to 2018, the volume of all-cause revision TSA increased 173%, while septic revision TSA increased 277%. By 2030, the estimated number of all-cause revision TSAs was projected to be 32,156, costing an estimated 738.4-millions dollars. Similarly, the estimated number of septic revision TSAs was projected to be upwards of 15,065 in 2030, costing 526.3-million dollars. We found preoperative opioid use increased complications, healthcare utilization, revision surgery, and PJI following TSA in a dose-dependent manner. The highest rate of complication was observed in those prescribed >25 oral-morphine-equivalents (OMEs) per day. These patients had an increased risk of 90-day readmission (Odds Ratio [OR]: 1.86, 95% confidence interval [CI]: 1.55-2.23), extended length of stay (OR: 2.05, CI: 1.84-2.28), a thromboembolic event (OR: 1.36, CI: 1.05-1.75), revision surgery (Hazard Ratio [HR]: 2.50, CI: 1.88-2.70), and PJI (HR: 2.80, CI: 2.25-3.49) when compared to opioid naive patients. We also found that patients receiving an injection within 30-days of surgery had an increased risk of PJI (HR: 1.67, CI: 1.21-2.32, p=0.002) compared to those not receiving an injection. No risk of PJI was seen in those receiving injections at 31-60 days (HR: 0.94, CI: 0.71-1.25) or 61-90 days (HR: 1.02, CI: 0.78-1.32) before surgery. Finally, those with a previous shoulder surgery within 4-years of their TSA had an increased risk of PJI compared to those without (HR: 1.91, CI: 1.36-2.68). We have identified three potentially modifiable risk factors for poor outcomes TSA. Care should be taken to address these risk factors preoperatively.

Table of Contents

a.     INTRODUCTION............................................................................................................................... pp. 1-2

b.     BACKGROUND.................................................................................................................................. pp. 3-5

c.     METHODS......................................................................................................................................... pp. 6-13

d.     RESULTS........................................................................................................................................... pp. 14-18

e.     DISCUSSION..................................................................................................................................... pp. 19-26

f.      REFERENCES.................................................................................................................................... pp. 27-39

g.     TABLES............................................................................................................................................. pp. 39-53

h.     FIGURES........................................................................................................................................... pp. 54-57

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