The role of antibiotic and drug allergies on adverse outcomes after shoulder arthroplasty: a nationwide database analysis of 153,384 patients

Abstract

Background

The goal of this study is to examine the impact of antibiotic and other drug allergies on the incidence of complications and revisions following shoulder arthroplasty (SA). Our hypothesis posits that patients with antibiotics or other drug allergies will have a higher rate of complications and revision surgeries following SA.

Methods

All data collection involved utilizing the PearlDiver national database and Current Procedural Terminology code 23472 to identify individuals who had undergone primary anatomic or reverse SA within the period of 1/1/2010-10/31/2021. The initial population was categorized into three groups: patients with antibiotic allergies, patients with other drug allergies, and patients with no reported drug allergies. The two allergy groups were examined against the nonallergy group to draw comparisons concerning surgical complications, medical complications, and revision surgeries. The evaluation of complications took place at the 30 day and 90 day postoperative time points, while revisions were assessed at the 30 day, 1 year, 3 year, 5 year, and 10 year postoperative time points.

Results

This database study identified 153,384 patients (10,106 with antibiotic allergies, 16,982 with other drug allergies, and 126,296 with no allergies) who had received SA. Compared to patients without allergies, patients in both allergy cohorts were more likely to require revision surgery across all analyzed time points (P < .001). Patients with antibiotic allergies experienced higher rates of surgical site infections (SSI) (30 days: 1.0% vs. 0.8%, odds ratio 1.25 [95% confidence interval 1.02-1.53], P = .04; 90 days: 1.3% vs. 1.1%, 1.26 [1.06-1.51], P = .011) and prosthetic joint infections (30 days: 0.6% vs. 0.2%, 2.57 [2.06-3.27], P < .001; 90 days: 0.9% vs. 0.3%, 2.60 [2.06-3.27], P < .001) at both time points. Patients with allergies to other drugs were more likely to develop prosthetic joint infection (30 days: 0.6% vs. 0.2%, 2.57 [2.06-3.21], P < .001; 90 days: 0.8% vs. 0.3%, 2.51 [2.08-3.04], P < .001), but there was no statistical difference in SSI rates compared to patients without allergies (30 days: 0.9% vs. 0.8%, 1.10 [0.93-1.31], P = .279; 90 days: 1.2% vs. 1.1%, 1.16 [1.00-1.34], P = .055).

Discussion

Patients with antibiotic and other drug allergies demonstrated a higher likelihood of requiring revision surgery after undergoing SA. Patients with antibiotic allergies displayed an increased susceptibility to all complications analyzed apart from bleeding, while patients with other drug allergies displayed an increased susceptibility to all complications except for SSIs.