Martino John A, Guareschi Alexander S, Rogalski Brandon L, Eichinger Josef K, Friedman Richard J
Medical University of South Carolina, Charleston, SC, USA.
Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA.
Shoulder Elbow. 2024 Dec 18:17585732241306098. doi: 10.1177/17585732241306098.
Cirrhosis is a known risk factor for morbidity and mortality following surgical procedures and has been associated with increased complications, hospital length of stay (LOS), and cost of admission following total joint arthroplasty. However, a paucity of literature exists evaluating the effect of cirrhosis on postoperative outcomes following total shoulder arthroplasty (TSA). The purpose of this study is to evaluate the short-term outcomes following elective primary TSA in patients with cirrhosis compared to matched controls.
The Nationwide Readmissions Database was queried from 2016 to 2020 to identify patients who underwent elective primary TSA. Patients with a diagnosis of cirrhosis ( = 627) were matched in a 1:1 proportion to patients who did not have cirrhosis. Bivariate statistical analyses were performed to compare preoperative demographic and comorbidity data, postoperative outcomes, and hospital utilization metrics between the two groups. Following Bonferroni correction, an alpha value of 0.003 defined significance.
Patients with cirrhosis exhibited higher rates of postoperative medical and implant-related complications following primary TSA, including acute renal failure (6.3% vs 1.1%: < 0.001), urinary tract infection (3.5% vs 0.6%; < 0.001), transfusions (3.0% vs 0.2%; < 0.001), acute respiratory distress syndrome (2.9% vs 0.2%: = 0.002), surgical site infection (2.0% vs 0.2%: = 0.001), dislocation (2.1% vs 0.0%: < 0.001), and prosthetic loosening (1.5% vs 0.0%; = 0.002). These patients also exhibited higher rates of all-cause complications (32% vs 9.2%: < 0.001) and mortality (1.5% vs 0.0%; = 0.002) within 180 days of surgery and had an increased cost of admission ($24,633 vs $18,500; < 0.001) and LOS (2.6 vs 1.5 days; < 0.001).
Patients with cirrhosis were found to have increased risk of medical and surgical complications, higher costs, and longer LOS following TSA. These findings can assist orthopedic surgeons in developing strategies in the preoperative period to mitigate complications in this at-risk patient group.
Level III - Retrospective cohort study.
肝硬化是外科手术后发病和死亡的已知风险因素，与全关节置换术后并发症增加、住院时间延长及住院费用增加有关。然而，关于肝硬化对全肩关节置换术（TSA）术后结果影响的文献较少。本研究的目的是评估肝硬化患者与匹配对照组在择期初次TSA后的短期结果。
查询2016年至2020年的全国再入院数据库，以识别接受择期初次TSA的患者。将诊断为肝硬化的患者（n = 627）与未患肝硬化的患者按1:1比例匹配。进行双变量统计分析，以比较两组患者术前的人口统计学和合并症数据、术后结果及医院利用指标。经过Bonferroni校正后，α值为0.003定义为具有统计学意义。
肝硬化患者在初次TSA后出现术后医疗和植入物相关并发症的发生率较高，包括急性肾衰竭（6.3%对1.1%；P < 0.001）、尿路感染（3.5%对0.6%；P < 0.001）、输血（3.0%对0.2%；P < 0.001）、急性呼吸窘迫综合征（2.9%对0.2%；P = 0.002）、手术部位感染（2.0%对0.2%；P = 0.001）、脱位（2.1%对0.0%；P < 0.001）和假体松动（1.5%对0.0%；P = 0.002）。这些患者在术后180天内全因并发症发生率（32%对9.2%；P < 0.001）和死亡率（1.5%对0.0%；P = 0.002）也较高，且住院费用增加（24,633美元对18,500美元；P < 0.001），住院时间延长（2.6天对1.5天；P < 0.001）。
发现肝硬化患者在TSA后发生医疗和手术并发症的风险增加、费用更高且住院时间更长。这些发现可帮助骨科医生在术前制定策略，以减轻这一高危患者群体的并发症。
III级——回顾性队列研究。
