Inflammatory bowel disease is an independent predictor for complications following total shoulder arthroplasty

Abstract

Background

The demand for total shoulder arthroplasty (TSA) in patients with inflammatory bowel disease (IBD) is expected to increase. The purpose of this study is to determine the perioperative outcomes in patients with IBD (Crohn’s disease [CD] and ulcerative colitis [UC]) compared to those without IBD following primary TSA.

Methods

The National Readmission Database was queried to identify 683 patients with CD and 566 patients with UC undergoing primary TSA between 2010 and 2020. Case–control matching generated controls in a 1:3 proportion based on age, sex, and preoperative medical diagnoses. Primary outcomes included postoperative medical and surgical complications, clinical outcomes within 180 days, total hospital length of stay, discharge disposition, and total costs of care after TSA. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Multivariate analyses identified independent risk factors for postoperative complications after TSA.

Results

Compared to matched controls, patients with CD undergoing TSA had higher odds of complications including sepsis (OR 35, CI, 8.2-148), dislocation (OR 27, 3.4-211), prosthetic loosening (OR 21, 2.5-168), transfusion requirement (OR 8.9, CI, 2.9-28), and acute respiratory distress syndrome (OR 8.5, CI, 3.3-22). Compared to matched controls, patients with UC undergoing TSA had higher odds of sepsis (OR 15, CI, 1.7-129), acute respiratory distress syndrome (OR 7.9, CI, 2.8-22), and acute renal failure (OR 3.2, CI, 1.7-6.0). No differences in rates of readmission, revision TSA, or mortality were observed between the 2 groups relative to their controls. Total cost of care ($20,808 vs. $17,488) was higher in patients with UC. However, length of stay and discharge disposition was similar to matched controls for both CD and UC patients. On multivariate analysis, CD and UC were identified as independent risk factors for medical and implant-related complications, including dislocation and prosthetic loosening (P < .001).

Conclusion

IBD is an independent risk factor for higher rates of medical and surgical complications following primary TSA. This information can help orthopedic surgeons appropriately counsel patients with IBD on the risks following TSA.