Bahoravitch Tyler J, Jami Meghana, Nayar Suresh K, Agarwal Amil, Kreulen R Timothy, Best Matthew J, Srikumaran Uma
From the George Washington University School of Medicine, Washington DC (Bahoravitch and Agarwal), Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Jami, Kreulen, Best, and Srikumaran), Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Nayar).
J Am Acad Orthop Surg. 2022 Oct 1;30(19):e1249-e1259. doi: 10.5435/JAAOS-D-21-01167. Epub 2022 May 17.
Periprosthetic infections after total shoulder arthroplasty (TSA) are associated with devastating complications and prolonged treatment. Patients with identified antibiotic allergy (ABX) may be at increased risk for complications because of suboptimal preincisional prophylaxis. This study aims to quantify the risk of postoperative outcomes and complications for patients undergoing TSA with a history of ABX.
Retrospective cohort analysis of patient data was conducted using the PearlDiver Patient Records Database. Patients who underwent TSA for osteoarthritis were identified using Current Procedural Terminology and International Classification of Diseases codes and were stratified based on self-reported (1) penicillin, (2) sulfonamide, or (3) other antibiotic allergies. We analyzed patient demographics, comorbidities, 90-day medical complications, and rate of revision at 30 days, 90 days, 1 year, and 2 years.
In total, 85,606 patients who underwent TSA for osteoarthritis from 2010 to 2018 were identified, of whom 7,836 (9.15%) had a reported ABX. Univariate analysis found the ABX cohort was younger (67.5 versus 67.7 year; P = 0.042), more often female (67.57% versus 54.79%; P < 0.001), and more likely to have Elixhauser comorbidities than nonallergic control subjects. Multivariate analysis found patients who reported ABX had increased likelihood of periprosthetic joint infection (PJI) within 30 days (odds ratio [OR]: 3.129), 1 year (OR: 2.016), and 2 years of surgery (OR: 2.221). Patients with reported ABX had increased likelihood of postoperative anemia (OR: 1.126), blood transfusion (OR: 1.238), and readmission (OR: 1.585) within 90 days of surgery. Patients with penicillin allergy had a greater incidence of revision due to PJI at 30 days (OR: 4.811), 90 days (OR: 2.91), 1 year (OR: 2.105), and 2 years (OR: 2.72). Rates of reported ABX increased from 2010 to 2018 (8.60% to 10.91%; P = 0.001) in patients undergoing TSA.
Patients undergoing TSA with a history of ABX had a higher risk of readmission, postoperative anemia, blood transfusions, and PJI. These findings support critical assessment and clarification of reported allergies before TSA and possibly the use of preoperative allergy testing.
Level 3 therapeutic study.
全肩关节置换术（TSA）后假体周围感染与严重并发症及延长治疗相关。已确诊有抗生素过敏（ABX）的患者，由于术前预防措施欠佳，可能发生并发症的风险增加。本研究旨在量化有ABX病史的TSA患者术后结局及并发症的风险。
使用PearlDiver患者记录数据库对患者数据进行回顾性队列分析。通过当前操作术语和国际疾病分类代码识别因骨关节炎接受TSA的患者，并根据自我报告的（1）青霉素、（2）磺胺类药物或（3）其他抗生素过敏进行分层。我们分析了患者的人口统计学、合并症、90天医疗并发症以及30天、90天、1年和2年的翻修率。
总共识别出2010年至2018年因骨关节炎接受TSA的85606例患者，其中7836例（9.15%）报告有ABX。单因素分析发现，ABX队列患者更年轻（67.5岁对67.7岁；P = 0.042），女性更多（67.57%对54.79%；P < 0.001），并且与非过敏对照受试者相比，更可能有埃利克斯豪泽合并症。多因素分析发现，报告有ABX的患者在术后30天内（比值比[OR]：3.129）、1年（OR：2.016）和2年内发生假体周围关节感染（PJI）的可能性增加（OR：2.221）。报告有ABX的患者在术后90天内发生贫血（OR：1.126）、输血（OR：1.238）和再次入院（OR：1.585）的可能性增加。青霉素过敏患者因PJI在30天（OR：4.811）、90天（OR：2.91）、1年（OR：2.105）和2年（OR：2.72）进行翻修的发生率更高。接受TSA的患者中报告的ABX发生率从2010年到2018年有所增加（8.60%至10.91%；P = 0.001）。
有ABX病史的TSA患者再次入院、术后贫血、输血和PJI的风险更高。这些发现支持在TSA前对报告的过敏情况进行严格评估和明确，可能还需进行术前过敏测试。
3级治疗研究。
