Total shoulder arthroplasty: ninety-day adverse events and 5-year implant survival in patients with hidradenitis suppurativa

Abstract

BackgroundThe goal of this study was to determine the effect, if any, that hidradenitis suppurativa (HS) had on outcomes following total shoulder arthroplasty (TSA). Based on the proximity of the suppurative lesions to the incision site, it was hypothesized that it would lead to increased risk of infection. HS is a chronic skin disorder that is characterized by skin lesions, primarily affecting the axillary and inguinal regions. The skin lesions of HS are known to be sites of bacterial growth, and are thus a potential risk factor for infection for procedures done in those regions, such as a TSA. MethodsAdult patients undergoing TSA for degenerative conditions were identified from the Pearldiver MUExtr dataset. HS patients were matched 1:4 to non-HS based on age, sex, and Elixhauser Comorbidity Index due to differences between the nonmatched cohorts. The incidence of the 90-day any, severe, and minor adverse events, as well surgical site infection and wound dehiscence were tabulated and compared using both univariate and multivariate analyses. The 5-year revision rates of the matched cohorts were plotted using Kaplan-Meier survival curves and compared with a log rank Mantel-Cox test. ResultsOf 118,269 TSA patients identified, HS was noted for 218 patients (0.18%). After matching, HS patients were at significantly increased risk of 90-day any adverse event (odds ratio [OR]: 1.69, P = .03), severe adverse event (OR: 2.13, P = .03), minor adverse event (OR: 1.85, P = .02), surgical site infection (OR: 9.85, P = .001), and wound dehiscence (OR: 2.55, P = .002). There were no significant differences between the HS and non-HS groups in terms of 90-day readmissions (P = .34) or 5-year reoperation rates (95.7% vs. 98.1%, P = .097). ConclusionsHS is a rare comorbidity for TSA patients (0.18%). Not only do these patients have a significantly higher comorbidity burden, but after matching were also found to have a significantly increased risk of 90-day postoperative complications, which were most notably surgical site infections and wound dehiscence. Nonetheless, five-year implant survival was similar for those with and without HS in the present study. These findings may help with the required surgical planning in terms of postoperative management of these patients to manage these potential complications.