Analysis of perioperative morbidity and mortality in shoulder arthroplasty patients with preexisting alcohol use disorders

Ponce, Brent A.; Oladeji, Lasun O.; Raley, James A.; Menendez, Mariano E.

doi:10.1016/j.jse.2014.05.019

Cited by 24 publications

(21 citation statements)

References 41 publications

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“…Third, although the use of administrative databases reduces the risk of missing patients and drop-out during follow-up, risks of inadequate registration, misclassification, and insufficient encoding still exist [4,46]. When compared to other sources of data, certain diagnoses appear to be underreported in the Danish National Patient Register [5,47].…”

Section: Discussionmentioning

confidence: 99%

“…The 90-day and 1-year risks of mortality were set as primary outcomes. Prosthetic infection (ICD-10: T845-847), cardiovascular disease (ICD-10: I63-64, G458-459, I21-22) and deep venous thrombosis (ICD-10: I801-803, I809) were set as secondary outcomes, as these postoperative complications have especially been associated with patients with high or excessive alcohol consumption or alcohol abuse [1,4,32–34]. To comply with the EPCO guidelines, the 1-year risk of prosthetic infection and 30-day risks of cardiovascular disease and deep venous thrombosis were examined.…”

Section: Methodsmentioning

confidence: 99%

“…To address the importance of preoperative alcohol consumption in the prognosis of adverse postoperative outcomes without excessive confounding by multiple risk profiles, we selected an orthopedic population that underwent elective primary hip or knee arthroplasty that have received little attention in previous research [3,4]. Therefore, the aim of this study was to investigate the relationship between preoperative alcohol consumption, with a focus on abstainers and low-to-moderate consumers, and the risks of postoperative mortality and morbidity following primary hip or knee arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

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Alcohol consumption and the risk of postoperative mortality and morbidity after primary hip or knee arthroplasty – A register-based cohort study

et al. 2017

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ObjectiveTo investigate the implications of low and moderate preoperative alcohol consumption on postoperative mortality and morbidity after primary hip and knee arthroplasty.MethodsA total of 30,799 patients who underwent primary hip or knee arthroplasty between January 1st, 2005 and October 8th, 2011 with information on preoperative alcohol consumption (0 grams of pure alcohol/week, >0–168 g/week, >168–252 g/week, and >252 g/week) were identified through the Danish Anesthesia Database. The 90-day and 1-year risks of mortality (primary outcomes), 1-year risk of prosthetic infection, and 30-day risks of cardiovascular disease and deep venous thrombosis (secondary outcomes) were estimated by Cox regression analysis.ResultsWe identified 285 (0.9%) deaths within the first 90 days and 694 (2.3%) within the first year. Within the first 30 days, 209 (0.7%) and 270 (0.9%) patients had acquired cardiovascular disease and deep venous thrombosis, respectively, and 514 (1.7%) patients developed prosthetic infection within the first year. The adjusted mortality models yielded hazard ratios of 0.55 (95% confidence interval [CI] 0.41 to 0.74) at 90 days and 0.61 (95% CI 0.51 to 0.73) at 1 year for the group consuming >0–168 g/week when compared to abstainers. Adjusted hazard ratios showed that the group consuming >0–168 g/week had a 0.91 (95% CI 0.75 to 1.11) risk of prosthetic infection, 0.68 (95% CI 0.50 to 0.92) risk of cardiovascular disease and 0.88 (95% CI 0.67 to 1.15) risk of deep venous thrombosis when compared to abstainers.ConclusionsThis study demonstrates that low-to-moderate alcohol consumption prior to primary hip or knee arthroplasty is associated with lower risks of mortality at both 90 days and 1 year after surgery and of cardiovascular disease after 30 days. More research from longitudinal studies is needed to identify specific causal relations and explanations.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Alcohol consumption and the risk of postoperative mortality and morbidity after primary hip or knee arthroplasty – A register-based cohort study

et al. 2017

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“…A similar study of a joint registry reported 0.5% prevalence of substance use disorders in 2,831 THA patients. 37 Ponce et al, 38 an NIS study of the effects of alcohol use in total shoulder arthroplasty (TSA) and shoulder hemiarthroplasty reported a 1.3% prevalence of alcohol use disorder in 422,371 patients. Several studies have found conflicting prevalence rates for mental health conditions, although these may be closer to the true prevalence.…”

Section: Discussionmentioning

confidence: 99%

Greater Prevalence of Mental Health Conditions in Septic Revision Total Knee Arthroplasty: A Call to Action

et al. 2020

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The purpose of this study was to compare the prevalence of mental health conditions among patients undergoing (1) primary total knee arthroplasty (pTKA), (2) septic revision total knee arthroplasty (rTKA), and (3) aseptic revision total knee arthroplasty (TKA). The State Inpatient Databases were queried for all TKAs from 2005 to 2014 yielding 563,144 patients. Patients were separated into the following cohorts: primary, septic revision, and aseptic revision. Diagnoses of any mental health condition and the following specific conditions were compared between the three cohorts: schizophrenia/delusion, bipolar disorder, depression/mood disorder, personality disorder, anxiety/somatic/dissociative disorder, eating disorders, attention deficit hyperactivity disorder /conduct/impulse control, alcohol abuse, and drug abuse. Throughout the study period, an increase in the prevalence of mental health conditions was observed in septic and aseptic revision patients. Overall, there was a significantly higher prevalence of mental health conditions in the septic revision cohort (22.7%) compared with the primary (17.8%, p < 0.001) and aseptic revision (20.0%, p < 0.001) cohorts. Specifically, septic revision TKA patients had a higher prevalence of depression (p < 0.001), alcohol abuse (p < 0.001), drug abuse (p < 0.001), schizophrenia (p = 0.0007), and bipolar disorder (p < 0.001), compared with primary TKA patients. Additionally, there was a significantly higher prevalence of depression (p < 0.001), alcohol abuse (p < 0.001), and drug abuse (p < 0.001) among septic revision patients compared with aseptic revision patients. Mental health conditions were significantly higher among septic revision patients. Alcohol and drug abuse were approximately twice as prevalent in septic revision patients compared with primary and aseptic revision patients. These findings should serve as a call to action for mental health support for patients suffering from PJI.

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“…A review of current literature reveals that databases such as NIS have been used to analyze pertinent medical questions. 10,[13][14][15] This study was exempt from approval by the authors' institutional review board because all data used were deidentified before use and commercially available.…”

Section: Methodsmentioning

confidence: 99%

Early Postoperative Complications After Shoulder Arthroplasty in Patients With Epilepsy

Churchill¹,

Menendez²,

Ponce³

2016

Orthopedics

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Epilepsy is the most common serious neurological disorder in the United States, but little is known about its effect in the perioperative shoulder surgery setting. The authors sought to determine whether patients with epilepsy undergoing shoulder arthroplasty would be at increased risk for in-hospital adverse events, prolonged length of stay, and nonroutine disposition. Using the National Inpatient Sample (2002-2011), 422,371 adults undergoing shoulder arthroplasty were identified, 3714 (0.9%) of whom had epilepsy. Comparisons of perioperative outcomes were performed by multivariable logistic regression modeling. The authors found that patients with epilepsy were more likely to experience postoperative adverse events (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.54-1.84), including mechanical ventilation (OR, 3.91; 95% CI, 2.81-5.44), gastrointestinal complication (OR, 3.86; 95% CI, 2.78-5.37), deep venous thrombosis (OR, 3.23; 95% CI, 2.22-4.69), pneumonia (OR, 1.66; 95% CI, 1.35-2.04), posthemorrhagic anemia (OR, 1.57; 95% CI, 1.42-1.73), transfusion (OR, 1.56; 95% CI, 1.41-1.72), and acute renal failure (OR, 1.34; 95% CI, 1.04-1.74). An epilepsy diagnosis was also associated with increased odds for prolonged hospital stay (OR, 1.39; 95% CI, 1.28-1.52) and nonroutine discharge (OR, 1.80; 95% CI, 1.67-1.94). This study concludes that patients with epilepsy are at higher risk for early postoperative complications and resource use following shoulder arthroplasty surgery. Awareness of these risks may allow more targeted perioperative management of these patients to optimize postoperative outcomes and limit complications. [Orthopedics. 2016; 39(6):e1075-e1079.].

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Analysis of perioperative morbidity and mortality in shoulder arthroplasty patients with preexisting alcohol use disorders

Cited by 24 publications

References 41 publications

Alcohol consumption and the risk of postoperative mortality and morbidity after primary hip or knee arthroplasty – A register-based cohort study

Alcohol consumption and the risk of postoperative mortality and morbidity after primary hip or knee arthroplasty – A register-based cohort study

Greater Prevalence of Mental Health Conditions in Septic Revision Total Knee Arthroplasty: A Call to Action

Early Postoperative Complications After Shoulder Arthroplasty in Patients With Epilepsy

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