Curtailing infection risks in hepatitis C patients: the effect of antiviral treatment in revision shoulder arthroplasty

Abstract

BackgroundRevision shoulder arthroplasty (RevSA) is a complex procedure that can result in various postoperative complications. However, the impact of hepatitis C virus (HCV) on postoperative complications after RevSA remains unclear due to limited and inconsistent evidence. This study aims (1) to investigate the incidence of postoperative complications in patients with HCV undergoing RevSA, and (2) to evaluate the impact of HCV treatment on complication rates at different time points after the revision procedure, specifically at 90 days, 1 year, and 2 years MethodsWe queried a national, all-payer database to investigate recent trends in the utilization of RevSA among HCV patients to assess postoperative complication rates, including venous thromboembolism, wound complication, transfusion, and prosthetic joint infection. Statistical analyses involved propensity score matching to create balanced cohorts and logistic regression to determine the relative risk of postoperative complications. "Data was analyzed with the SPSS Statistics software (version 24.0 for Windows; IBM, Armonk, NY, USA). The study included patients who underwent partial or total RevSA procedures between January 1, 2010, and December 31, 2020. Patients were identified based on medical claims that included procedural codes for RevSA and associated diagnosis codes for PJI or insertion/removal of an antibiotic spacer. A Bonferroni correction was utilized because many tests were performed and statistical significance was set at p=0.0125. ResultsThe HCV cohort demonstrated higher prosthetic joint infection (PJI) rates at one-year (5.5 vs 3.9%, p=0.006) and two-year follow-ups (6.7 vs 4.6%, p=0.006). However, no significant differences emerged in venous thromboembolism (VTE) and wound complications rates between the HCV and non-HCV cohorts. Comparing untreated and treated HCV patients, the former showed significantly higher PJI rates at two-year p=0.010, while the treated group had significantly lower odds ratios for PJI. When comparing treated HCV patients with the no HCV cohort, minimal differences were found in postoperative outcomes, indicating no significant difference in the risk of complications between the groups ConclusionOur study observed an association between HCV patients who received antiviral treatment prior to RevSA and a reduced incidence of PJI compared to untreated HCV patients. When comparing this group to the non-HCV controls, there was no significant difference in the incidence of PJI, suggesting a potential association between antiviral treatment and the observed risk patterns in HCV patients. Proper management of HCV-positive patients during RevSA is crucial for improving outcomes and reducing complications.