Su Favian, Cogan Charles J, Bendich Ilya, Zhang Ning, Whooley Mary A, Kuo Alfred C
Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
JSES Int. 2021 Apr 20;5(4):699-706. doi: 10.1016/j.jseint.2021.02.009. eCollection 2021 Jul.
Few studies have evaluated the effect of hepatitis C (HCV) on primary total shoulder arthroplasty (TSA). Our purpose was to determine if HCV infection is associated with increased complication rates after TSA in United States (US) veterans and, secondarily, to determine if preoperative HCV treatment with direct-acting antivirals (DAAs) affects postoperative complication rates.
US Department of Veterans Affairs (VA) data sets were used to retrospectively identify patients without HCV, patients with untreated HCV, and patients with HCV treated with DAAs who underwent TSA from 2014 to 2019. Medical and surgical complications were assessed using International Classification of Diseases codes. Complication rates between patients with HCV (treated and untreated) and patients without HCV and between HCV-treated patients and HCV-untreated patients were compared at 90 days and 1 year after surgery.
We identified 5774 primary TSAs that were performed at VA hospitals between 2014 and 2019. A minority (9.5%) of TSA patients had HCV, 23.4% of whom were treated preoperatively with DAAs. On multivariate analysis, HCV patients had increased odds of 1-year medical complications (odds ratio, 1.39; 95% confidence interval, 1.06-1.81, = .016), when compared with patients without HCV. No statistically significant difference in complication rates was observed between HCV-treated and HCV-untreated patients.
US veterans with a history of HCV are at an increased risk of developing medical but not surgical complications within the first year after TSA. Larger studies are necessary to evaluate the effects of DAA treatment on complication rates.
很少有研究评估丙型肝炎（HCV）对初次全肩关节置换术（TSA）的影响。我们的目的是确定HCV感染是否与美国退伍军人TSA术后并发症发生率增加相关，其次，确定术前使用直接作用抗病毒药物（DAA）治疗HCV是否会影响术后并发症发生率。
利用美国退伍军人事务部（VA）数据集，回顾性识别2014年至2019年接受TSA的无HCV患者、未经治疗的HCV患者和接受DAA治疗的HCV患者。使用国际疾病分类编码评估医疗和手术并发症。比较HCV患者（治疗和未治疗）与无HCV患者之间以及HCV治疗患者与未治疗HCV患者之间在术后90天和1年时的并发症发生率。
我们确定了2014年至2019年在VA医院进行的5774例初次TSA。少数（9.5%）TSA患者患有HCV，其中23.4%在术前接受了DAA治疗。多变量分析显示，与无HCV患者相比，HCV患者发生1年医疗并发症的几率增加（比值比，1.39；95%置信区间，1.06 - 1.81，P = 0.016）。HCV治疗患者与未治疗HCV患者之间的并发症发生率未观察到统计学显著差异。
有HCV病史的美国退伍军人在TSA术后第一年内发生医疗并发症而非手术并发症的风险增加。需要更大规模的研究来评估DAA治疗对并发症发生率的影响。
