Exploring the Impact of Bleeding Disorder Diagnosis on Postoperative Complications Following Total Shoulder Arthroplasty in Adults
Abstract
Introduction and Objective. Total shoulder arthroplasty (TSA) is a common orthopedic procedure. Although modern management techniques have been shown to reduce adverse outcomes, the incidence of postoperative complications in adult patients with bleeding disorders undergoing TSA remains poorly understood. The aim of this study was to explore the impact of bleeding disorder diagnosis on postoperative complications following TSA in adults. Our hypothesis was that patients diagnosed with a bleeding disorder would have a higher frequency of postoperative complications compared with patients without a bleeding disorder. Methods. We conducted a retrospective cohort study in adult patients undergoing TSA using de-identified data from the National Surgical Quality Improvement Program (NSQIP) database (2011-2016). Patients over the age of 18 undergoing TSA (CPT23472) with and without bleeding disorders were included in the study and were evaluated with postoperative complications, death, reoperation, and transfusion as outcomes. Patients were assessed according to age, sex, race, and various comorbidities. Statistical methods included bivariate analysis on overall and individual complication rates, time-to-event analyses for each complication, and a Cox (proportional hazards) regression analysis to account for confounding variables. Results. The patients with bleeding disorders (n=367), as compared to those without bleeding disorders (n=12,906), were older, more often male, and had a higher preoperative frequency of diabetes, dyspnea, hypertension, congestive heart failure, chronic obstructive pulmonary disease, on dialysis, and needing preoperative transfusion. They also had a higher percentage of elevated ASA classifications, indicating more compromised physical status. Bleeding disorders were significantly associated with higher frequency of postoperative complications (adjusted HR 1.62, 95% CI 1.26-2.09), death (aHR 4.0, 95% CI 1.2-13.7), and transfusion (aHR 2.44, 95% CI 1.64-3.64). However, bleeding disorders were not significantly associated with higher frequency of reoperation (aHR 1.28, 95% CI 0.90-1.84). Conclusions-Implications. Patients with bleeding disorders have higher risks of complications, death, and transfusion after TSA than patients without bleeding disorders. These patients may require increased surveillance including more careful preoperative evaluation and optimization, proper intraoperative hemostasis, as well as more intensive postoperative monitoring and management.
Abstract Category
23. Orthopedics
Secondary Abstract Category
28. Surgery
Keywords
Total Shoulder Arthroplasty, Bleeding Disorders, Postoperative Complications
Presentation Type
Poster Presentation
Exploring the Impact of Bleeding Disorder Diagnosis on Postoperative Complications Following Total Shoulder Arthroplasty in Adults
Introduction and Objective. Total shoulder arthroplasty (TSA) is a common orthopedic procedure. Although modern management techniques have been shown to reduce adverse outcomes, the incidence of postoperative complications in adult patients with bleeding disorders undergoing TSA remains poorly understood. The aim of this study was to explore the impact of bleeding disorder diagnosis on postoperative complications following TSA in adults. Our hypothesis was that patients diagnosed with a bleeding disorder would have a higher frequency of postoperative complications compared with patients without a bleeding disorder. Methods. We conducted a retrospective cohort study in adult patients undergoing TSA using de-identified data from the National Surgical Quality Improvement Program (NSQIP) database (2011-2016). Patients over the age of 18 undergoing TSA (CPT23472) with and without bleeding disorders were included in the study and were evaluated with postoperative complications, death, reoperation, and transfusion as outcomes. Patients were assessed according to age, sex, race, and various comorbidities. Statistical methods included bivariate analysis on overall and individual complication rates, time-to-event analyses for each complication, and a Cox (proportional hazards) regression analysis to account for confounding variables. Results. The patients with bleeding disorders (n=367), as compared to those without bleeding disorders (n=12,906), were older, more often male, and had a higher preoperative frequency of diabetes, dyspnea, hypertension, congestive heart failure, chronic obstructive pulmonary disease, on dialysis, and needing preoperative transfusion. They also had a higher percentage of elevated ASA classifications, indicating more compromised physical status. Bleeding disorders were significantly associated with higher frequency of postoperative complications (adjusted HR 1.62, 95% CI 1.26-2.09), death (aHR 4.0, 95% CI 1.2-13.7), and transfusion (aHR 2.44, 95% CI 1.64-3.64). However, bleeding disorders were not significantly associated with higher frequency of reoperation (aHR 1.28, 95% CI 0.90-1.84). Conclusions-Implications. Patients with bleeding disorders have higher risks of complications, death, and transfusion after TSA than patients without bleeding disorders. These patients may require increased surveillance including more careful preoperative evaluation and optimization, proper intraoperative hemostasis, as well as more intensive postoperative monitoring and management.