Pre-operative methicillin-resistant Staphylococcus aureus colonization increases the risk of 90-day medical and 2-year implant-related complications following primary total shoulder arthroplasty: a propensity-matched analysis.

Reverse total shoulder arthroplasty for proximal humerus fracture: a complex episode of care associated with increased surgical and medical complications

Patient outcomes after revision total shoulder arthroplasty in an inpatient vs. outpatient setting.

Total shoulder arthroplasty (TSA) is a highly successful procedure for management of glenohumeral arthritis, fractures and rotator cuff tears. The purpose of this study was to evaluate patient demographics, perioperative outcomes and assess recent national trends in both primary and revision TSA. The National Hospital Discharge Survey database was searched for patients admitted to US hospitals for primary and revision TSA from 2001 to 2010. A total of 1,297 patients who underwent primary TSA and 184 patients who underwent revision TSA were identified. The rates of primary TSA (r = 0.88) and revision TSA (r = 0.85) both demonstrated a strong positive correlation with time. The mean patient age of the primary group was significantly higher than the revision group. Gender was not significantly different between the groups. There was no significant difference in the racial make-up between the revision and primary groups. African Americans accounted for 3.3% of primaries versus 4.3% of revisions (p = 0.615). Revision TSA patients had a significantly longer average LOS (3.06days vs 2.46days, p < 0.01), more medical comorbidities (6.0 vs 5.1 comorbidities, p < 0.01) and a higher rate of developing a myocardial infarction (2.2% versus 0%, p < 0.01) than the primary TSA group. This study demonstrates that the rate of TSA is rapidly increasing in the US, with over a four-fold increase in revisions and five-fold increase in primaries over the tenyears studied.

Racial and socioeconomic disparities in risk and reason for revision total shoulder arthroplasty.

BackgroundOver the last decade, total shoulder arthroplasty (TSA) has increasingly transitioned to the outpatient setting, where postoperative care pathways inherently limit the ability to deliver a full 24 hour course of intravenous antibiotic prophylaxis. Despite guideline recommendations, extended oral antibiotic prophylaxis is variably used after outpatient TSA, with limited evidence supporting this practice.MethodsA retrospective cohort study using the TriNetX database identified patients undergoing primary outpatient TSA between 2015 and 2025. Patients were stratified by receipt of extended oral antibiotic prophylaxis. Propensity score matching yielded two cohorts of 2647 patients each. Outcomes included periprosthetic joint infection (PJI), surgical site infection (SSI), all-cause revision, wound disruption, and emergency department utilization at 90 days and 1 year. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.ResultsAt 90 days, there were no significant differences in PJI (0.9% vs 0.5%; RR 1.20, 95% CI 0.96–3.84) or SSI (0.8% vs 0.5%; RR 1.67, 95% CI 0.82–3.40). At 1 year, PJI (1.6% vs 1.2%; RR 1.34, 95% CI 0.85–2.12) and SSI (1.1% vs 0.8%; RR 1.14, 95% CI 0.79–2.42) rates remained comparable between groups.DiscussionExtended oral antibiotic prophylaxis did not reduce infection-related outcomes following primary outpatient TSA.Level of evidenceIII, Retrospective cohort study.

BackgroundAlthough there is a growing concern and policy regarding infections or colonization caused by resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), the prognosis of MRSA infections compared to that of methicillin-susceptible Staphylococcus aureus (MSSA) infections remains controversial. Moreover, there have not been any studies comparing both the burden of disease and its impact on the healthcare economy between MRSA infection and colonization while adjusting for confounding factors. These comparisons are crucial for developing effective infection control measures and healthcare policies. We aimed to compare the disease and economic burden between MRSA and MSSA infections and between MRSA infection and colonization.MethodsWe retrospectively investigated data of 496 in-patients with MRSA or MSSA infections and of 1178 in-patients with MRSA infections or MRSA colonization from a university hospital in Japan from 2016 to 2021. We compared in-hospital mortality, length of stay, and hospital charges between in-patients with MRSA and MSSA infections and those with MRSA infections and MRSA colonization using multiple regressions. We combined surveillance data, including all microbiological test results, data on patients with infections, treatment histories, and clinical outcomes, to create the datasets.ResultsThere was no statistically significant difference in in-hospital mortality rates between matched MRSA vs. MSSA infections and MRSA infection vs. colonization. On the contrary, the adjusted effects of the MRSA infection compared to those of MSSA infection on length of stay and hospital charges were 1.21-fold (95% confidence interval [CI] 1.03–1.42, P = 0.019) and 1.70-fold (95% CI 1.39–2.07, P < 0.00001), respectively. The adjusted effects of the MRSA infection compared to those of MRSA colonization on length of stay and hospital charges were 1.41-fold (95% CI 1.25–1.58, P < 0.00001) and 1.53-fold (95% CI 1.33–1.75, P < 0.00001), respectively. Regarding confounding factors, hemodialysis or hemofiltration was consistently identified and adjusted for in the multiple regression analyses comparing MRSA and MSSA infections, as well as MRSA infection and MRSA colonization.ConclusionsMRSA infection was associated with longer length of stay and higher hospital charges than both MSSA infection and MRSA colonization. Furthermore, hemodialysis or hemofiltration was identified as a common underlying factor contributing to increased length of stay and hospital charges.

Iron deficiency anemia is associated with increased medical and implant-related complications and length of stay for patients undergoing total shoulder arthroplasty.

BACKGROUND As COVID-19 rapidly propagated, many institutions were forced to respond with suspension in all elective surgical procedures, including primary and revision Total Shoulder Arthroplasty (TSA). In 2021, the Centers of Medicare &amp; Medicaid Services (CMS) removed primary and revision TSA from the Inpatient-Only-List (IPO). These rapid changes created uncertainty surrounding the potential backlog of patients that healthcare systems could face. The purpose of this study is to observe the change in volume as well as proportion of TSA performed in the outpatient setting. METHODS Patients who underwent primary and revision elective TSA from January 2018 to April 2021 were identified using the Pearldiver database. Descriptive analysis was utilized to report the monthly changes in elective TSA volume and the proportion of the volume performed in the outpatient setting. A linear forecast analysis using historical data was utilized to determine the expected volume and proportion of TSA cases performed on an outpatient basis during the pandemic period. This was compared to the observed case volume and setting. RESULTS Within 3 months following suspension, the total volume had returned to expected for both primary and revision TSA. Those performed in the outpatient setting significantly increased throughout the pandemic, with the largest peak following January 2020. By April 2021, four months after the CMS removal of TSA from the IPO list, the backlog of primary TSA volume had decreased by 30.8% with respect that in December 2020. For revision TSA, the backlog was entirely overcome by April 2021 as there was an observed decrease of 131% with respect that in December 2020. CONCLUSION The backlog for both primary and revision TSA from the beginning of the pandemic has decreased. The observed decrease did not seem to start until January 2021 following CMS’ removal of TSA from the IPO list. Therefore, the reduction in the backlog may be associated with the increased utilization of outpatient primary and revision TSA.

There is a paucity of literature that examines how the abnormal spinopelvic alignment of scoliosis affects outcomes after total hip arthroplasty (THA) in the absence of a lumbar fusion. Patients with a history of scoliosis (idiopathic, adolescent, degenerative, or juvenile) without fusion and those without a history of scoliosis who underwent primary THA were identified using a large national database. Ninety-day incidence of various medical complications, emergency department (ED) visit, and readmission and 1-year incidence of surgery-related complications and cost of care were evaluated in both the scoliosis and control cohorts. Propensity score matching was used to control for patient demographic factors and comorbidities as covariates. After propensity matching, 21,992 and 219,920 patients were identified in the scoliosis and control cohorts, respectively. Patients with scoliosis were at increased risk of several 90-day medical complications, including pulmonary embolism (odds ratio [OR] 1.96; P < 0.001), deep vein thrombosis (1.49; P < 0.001), transfusion (OR, 1.13; P < 0.001), pneumonia (OR, 1.37; P < 0.001), myocardial infarction (OR, 1.38; P = 0.008), sepsis (OR, 1.59; P < 0.001), acute anemia (OR, 1.21; P < 0.001), and urinary tract infection (OR, 1.1; P = 0.001). Patients with a history of scoliosis were at increased 1-year risk of revision (OR, 1.31; P < 0.001), periprosthetic joint infection (OR, 1.16; P = 0.0089), dislocation (OR, 1.581; P < 0.001), and aseptic loosening (OR, 1.39; P < 0.001) after THA. Patients with scoliosis without a history of fusion were more likely to return to the emergency department (OR, 1.26; P < 0.001) and be readmitted (OR, 1.78; P < 0.001) within 90 days of THA. Patients with even a remote history of scoliosis without fusion are at increased risk of 90-day medical and surgery-related complications after hip arthroplasty. Hip and spine surgeons should collaborate in future studies to best understand how to optimize these patients for their adult reconstructive procedures.

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

Relative value units and reimbursement for primary and revision total shoulder arthroplasty

Perioperative intravenous dexamethasone use is not associated with periprosthetic joint infection or wound healing complications following shoulder arthroplasty

Trends in Medicare physician reimbursement and utilization for proximal humerus fixation and shoulder arthroplasty

The primary objective of this study was to examine the relationship between vitamin D deficiency and implant-related and medical complications following total shoulder arthroplasty. Using the PearlDiver database, patients who underwent total shoulder arthroplasty from 2005 to 2016 with vitamin D deficiency were identified. These were compared to a 3:1 control group matched by age, sex, and presence of a concomitant osteoporosis diagnosis. Primary outcome measures were implant-related complications (loosening, periprosthetic fracture, periprosthetic joint infection, and revision total shoulder arthroplasty) in addition to medical complications within 90 days of surgery. A multivariable logistic regression analysis was utilized to control for patient demographics and comorbidities. One thousand and six hundred and seventy-four patients with vitamin D deficiency were identified and compared to 5022 controls. There was a significantly higher rate of revision total shoulder arthroplasty in the vitamin D deficient patients compared to controls (2.3% versus 0.8%, odds ratio 3.3, p < 0.0001). After controlling for confounding variables, there were no significant differences in any of the remaining implant-related or medical complications with the exception of higher rates of urinary tract infections in patients with vitamin D deficiency. Vitamin D deficiency is associated with a higher rate of all-cause revision total shoulder arthroplasty but not medical complications compared to controls.Level of evidence: Level III case control study.

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