Eisenberg Matthew T, Hui Clayton, Nielsen Colby, Shah Anup, Lederman Evan S
Orthopedic Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, USA.
Orthopedics, University of Arizona College of Medicine - Phoenix, Phoenix, USA.
Cureus. 2025 Mar 12;17(3):e80491. doi: 10.7759/cureus.80491. eCollection 2025 Mar.
Introduction Reverse shoulder arthroplasty (RSA) is increasingly used to manage various degenerative and traumatic shoulder conditions. Prosthetic joint infection (PJI) remains a rare but serious complication, occurring in approximately 1-4% of cases. Given that colonoscopy can cause transient bacteremia - a potential risk factor for PJI - the current study aimed to determine whether undergoing diagnostic or invasive colonoscopy within one year after RSA is associated with an increased risk of PJI or all-cause revision surgery. Methods A retrospective cohort study was conducted using the PearlDiver All Payer Claims Database (MARINER). Patients who underwent RSA with at least three years of follow-up were identified and stratified into three groups: a control group (no colonoscopy), a diagnostic colonoscopy group, and an invasive colonoscopy group. The colonoscopy occurred within one year after undergoing the index procedure. Demographics, including age and sex, along with comorbidity data (using the Elixhauser Comorbidity Index), were collected. The primary outcomes assessed were the incidence of PJI and the rate of all-cause revision at 3 years postoperatively. Results A total of 1,244 patients in the diagnostic colonoscopy group, 2,973 in the invasive colonoscopy group, and 74,309 in the control group were identified. At three years postoperatively, the incidence of PJI was not significantly different between the diagnostic (3.94% vs. 3.29%, p = 0.20) or invasive (3.8% vs. 3.29%, p = 0.13) groups compared to controls. However, while the rate of all-cause revision in the diagnostic group (7.32% vs. 7.53%, p = 0.78) did not differ significantly from controls, the invasive colonoscopy group approached statistical significance (8.48% vs. 7.53%, p = 0.05) in univariate analysis and was statistically significant in multivariate analysis (OR = 1.63, p ≤ 0.01). Conclusion This study found that undergoing a diagnostic or invasive colonoscopy within one year after RSA does not increase the risk of PJI at three years postoperatively. However, patients who underwent invasive colonoscopy exhibited a higher rate of all-cause revision, which was statistically significant in multivariate analysis. These findings suggest that routine colonoscopy screening should not be deferred in RSA patients due to infection concerns, but the increased risk of revision following invasive colonoscopy highlights the need for further research to determine potential underlying factors.
引言
反肩关节置换术（RSA）越来越多地用于治疗各种退行性和创伤性肩部疾病。人工关节感染（PJI）仍然是一种罕见但严重的并发症，发生率约为1%-4%。鉴于结肠镜检查可导致短暂菌血症——PJI的一个潜在危险因素，本研究旨在确定RSA术后一年内进行诊断性或侵入性结肠镜检查是否会增加PJI或全因翻修手术的风险。
方法
使用PearlDiver全支付者索赔数据库（MARINER）进行一项回顾性队列研究。确定接受RSA且至少随访三年的患者，并将其分为三组：对照组（未进行结肠镜检查）、诊断性结肠镜检查组和侵入性结肠镜检查组。结肠镜检查在接受初次手术的一年内进行。收集人口统计学数据，包括年龄和性别，以及合并症数据（使用埃利克斯豪泽合并症指数）。评估的主要结局是术后3年PJI的发生率和全因翻修率。
结果
诊断性结肠镜检查组共1244例患者，侵入性结肠镜检查组共2973例患者，对照组共74309例患者。术后三年，诊断性结肠镜检查组（3.94%对3.29%，p = 0.20）或侵入性结肠镜检查组（3.8%对3.29%，p = 0.13）与对照组相比，PJI的发生率无显著差异。然而，虽然诊断性结肠镜检查组的全因翻修率（7.32%对7.53%，p = 0.78）与对照组无显著差异，但侵入性结肠镜检查组在单因素分析中接近统计学显著性（8.48%对7.53%，p = 0.05），在多因素分析中具有统计学显著性（OR = 1.63，p≤0.01）。
结论
本研究发现，RSA术后一年内进行诊断性或侵入性结肠镜检查不会增加术后三年PJI的风险。然而，接受侵入性结肠镜检查的患者全因翻修率较高，在多因素分析中具有统计学显著性。这些发现表明，不应因感染担忧而推迟RSA患者的常规结肠镜筛查，但侵入性结肠镜检查后翻修风险增加凸显了进一步研究以确定潜在潜在因素的必要性。
