The Association of Benign Prostatic Hyperplasia on Postoperative Complications and Periprosthetic Joint Infections Following Total Shoulder Arthroplasty

Abstract

Background A recently proposed risk factor for periprosthetic joint infections (PJI) in men is benign prostatic hyperplasia (BPH). The objective was to explore the association of BPH on 1) 90-day complications, 2) length of stay (LOS), 3) readmission rates, and 4) healthcare expenditures following total shoulder arthroplasty (TSA). Methods A retrospective query was performed using a nationwide claims database from January 2005 to March 2014 for male patients undergoing primary TSA. The study cohort included 5067 patients with BPH while 50,720 patients served as the comparison cohort. Logistic regression determined the association of BPH on complications and readmissions. A p value less than 0.001 was significant. Results Patients with BPH had higher incidence and odds (36.8 vs. 6.2%; OR: 2.73, p < 0.0001) of all ninety-day medical complications including PJIs (0.49 vs. 0.32%; OR: 1.54, p < 0.001). BPH patients had longer in-hospital LOS (3- vs. 2-days, p < 0.0001). Study group patients had higher 90-day episode of care reimbursements ($13,653 vs. $12,688), p < 0.0001). Conclusions BPH is associated with increased complications and healthcare expenditures following total shoulder arthroplasty. The investigation can be used to educate BPH patients of the possible adverse events which may occur within ninety-days following primary TSA for the treatment of glenohumeral osteoarthritis.

Symptomatic Benign Prostatic Hyperplasia Is Not Associated With a Higher Risk of Periprosthetic Joint Infections and Periprosthetic Joint Infection–related Revisions After Primary THA

“…Recent studies have investigated benign prostatic hyperplasia (BPH), particularly symptomatic BPH (sBPH), as a potential risk factor for periprosthetic joint infection (PJI) in total joint arthroplasty [6][7][8]21]. Two studies found sBPH to be associated with a higher risk of PJI 90 days after total shoulder arthroplasty [7] and at least 1 year after primary or revision THA and TKA [21]. Other studies found no association between sBPH and PJI within 2 years after reverse shoulder arthroplasty [6] and primary THA and TKA [8].…”

“…With the limited and conflicting evidence regarding the association between sBPH and PJI [6][7][8]21], there is no consensus about how important sBPH is among patients undergoing THA, and further investigation of this topic is warranted. As only two studies have compared the rate of PJI among THA patients with and without a history of sBPH [8,21]-one study was a single-institution study including revision procedures [21] and the other had a sample size of only 1745 primary THA patients [8]-we hoped to use a more robust sample size with a national database to settle the controversy on the association between sBPH and PJI after primary THA.…”