COVID-19 infection within 6 months prior to total shoulder arthroplasty is an independent predictor of postoperative complications

Background

The COVID-19 pandemic significantly disrupted elective orthopedic surgeries such as total shoulder arthroplasty (TSA). Recent studies have shown an increased risk of complications following elective orthopedic surgeries in patients with a recent COVID-19 diagnosis. However, similar research specifically addressing TSA is lacking. The purpose of this study is to determine whether preoperative COVID-19 infection within the 6 months before primary elective TSA is associated with increased postoperative complications and increased length of stay.

Methods

The Nationwide Readmissions Database was queried to identify patients undergoing elective primary TSA in 2021. A total of 1032 patients were identified with a prior history of COVID-19 infection within the 6 months before TSA. Prior COVID-19 patients were propensity score matched 1:1 on age, sex, Charlson-Deyo Comorbidity Index, and discharge weight to patients without a prior diagnosis of COVID-19 who underwent elective primary TSA in 2021. Demographic information, preoperative comorbidities, postoperative complications, and health-care resource utilization was compared between prior COVID-19 patients and controls. Binary logistic regression was used to identify independent predictors of complications.

Results

Prior COVID-19 patients had higher rates of in-hospital postoperative complications than control patients (P < .001). Prior COVID-19 patients had higher rates of specific complications than control patients, including débridement (P = .031), periprosthetic joint infection (PJI) (P < .001), acute respiratory distress syndrome (P < .001), acute renal failure (ARF) (P < .001), pulmonary embolism (P < .001), sepsis (P = .002), and urinary tract infection (P = .039). Following logistic regression analysis, history of a COVID-19 diagnosis was shown to be independently predictive of any in-hospital complication (P < .001), PJI (P = .006), and ARF (P < .001). Prior COVID-19 patients were found to have a longer hospital length of stay than controls (2.6 vs. 2.0; P < .001) but had similar total health-care costs ($77,426 vs. $74,912, P = .385).

Discussion

There is an increased risk of medical (acute respiratory distress syndrome, ARF, pulmonary embolism, sepsis, urinary tract infection) and surgical (PJI) complications following elective TSA in patients with COVID-19 infection less than 6 months before the TSA. These findings highlight the importance of preoperative risk assessment and counseling for this patient population. Potential risk mitigation strategies may include venous thromboembolic prophylaxis, postoperative antibiotics, and early medical comanagement.