Increased preoperative aspartate aminotransferase-to-platelet ratio index predicts complications following total shoulder arthroplasty

Abstract

This study investigates the association between aspartate aminotransferase-to-platelet ratio index (APRI), a noninvasive measure of liver function, and 30-day postoperative complications following total shoulder arthroplasty (TSA). The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent TSA between 2015 and 2021. The study population was divided into 4 groups based on preoperative APRI: normal/reference (APRI ≤ 0.5), mild fibrosis (0.5<APRI ≤ 0.7), significant fibrosis (0.7<APRI ≤ 1), and cirrhosis (APRI > 1). Multivariate logistic regression analysis was conducted to investigate the connection between preoperative APRI and postoperative complications. Compared to the reference group, significant fibrosis was independently associated with a greater likelihood of major complications (odds ratio [OR]: 1.82, 95% confidence interval [CI]: 1.11-2.99; P=.017), minor complications (OR: 2.70, 95% CI: 1.67-4.37; P<.001), pneumonia (OR: 5.78, 95% CI: 2.58-12.95; P<.001), blood transfusions (OR: 2.89, 95% CI: 1.57-5.32; P<.001), readmission (OR: 1.88, 95% CI: 1.10-3.21; P=.022), and non-home discharge (OR: 1.83, 95% CI: 1.23-2.73; P=.003). Cirrhosis was independently associated with a greater likelihood of minor complications (OR: 3.96, 95% CI: 2.67-5.88; P<.001), blood transfusions (OR: 5.85, 95% CI: 3.79-9.03; P<.001), failure to wean off a ventilator (OR: 9.10, 95% CI: 1.98-41.82; P=.005), and non-home discharge (OR: 2.06, 95% CI: 1.43-2.96; P<.001). Increasing preoperative APRI was associated with an increasing rate of postoperative complications following TSA.