Hyperhidrosis increases the risk of postoperative infections after shoulder arthroplasty and rotator cuff repair

Background

Hyperhidrosis (HH), or excessive sweating, has been associated with higher rates of infections. Despite being a relatively common condition, its impact on postoperative outcomes following orthopedic procedures in proximity to the axilla, such as rotator cuff repair (RCR) and shoulder arthroplasty (SA), remains unknown.

Methods

A retrospective cohort study was conducted using the TriNetX globally federated database. Patients with and without HH who underwent either RCR or SA were matched based on patient demographics and comorbidities. A standard difference of <0.1 was used to assess success of propensity score matching. Primary outcomes were 90-day postoperative superficial soft tissue infections (SSTIs), deep infections, and wound complications. Tests of significance and risk ratios (RR) with 95% confidence intervals were calculated.

Results

After matching, 2,941 patients who underwent RCR and 2,066 patients who underwent SA were identified in each cohort. HH patients undergoing RCR demonstrated a higher risk of SSTIs (RR = 1.81; P = .007), urinary tract infection (UTI; RR = 2.09; P < .001), and emergency services usage (RR = 1.69; P < .001). Similarly, HH patients undergoing SA were also at higher risk of SSTIs (RR = 1.87; P = .004), UTI (RR = 1.65; P = .003), and emergency services usage (RR = 1.54; P < .001). There was no significant difference in the rates of deep soft tissue infections between the HH and non-HH groups for both RCR and SA.

Discussion

HH is associated with an increased risk for 90-day complications including SSTIs, UTIs, and emergency services usage following both RCR and SA. Additional strategies for optimizing surgical care of these patients should be investigated.