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Total shoulder arthroplasty in patients with HIV infection: complications, comorbidities, and trends.
J Shoulder Elbow Surg. 2016 Dec; 25(12):1971-1979.JS

Abstract

BACKGROUND

Patients with human immunodeficiency virus (HIV) infection were previously at substantial risk for immunosuppression-related complications. As a result of highly active antiretroviral therapy, HIV-infected patients are living longer and are presenting for elective surgery. Outcomes in HIV-infected patients are well described for hip and knee arthroplasty but not for total shoulder arthroplasty (TSA). The purpose of this study was to examine postoperative complications of TSA in HIV-positive patients.

METHODS

We queried the entire 2005 to 2012 Medicare database. Current Procedural Terminology and International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify the procedure, demographics, comorbidities, and postoperative complications. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

RESULTS

The query returned 2528 HIV-positive patients who underwent TSA or reverse TSA (RTSA). There was increased utilization of TSA and RTSA in this population from 2005 to 2012; 1353 patients had 2-year follow-up. These patients were slightly older and had higher prevalence of comorbidities, suggesting a sicker cohort. HIV-positive patients had alarmingly higher rates of 90-day cerebrovascular accident (OR, 35.98; CI, 30.34-42.67). HIV-positive patients had higher overall rates of broken prosthetic joints (OR, 1.72; CI, 1.20-2.47), periprosthetic infection (OR, 1.36; CI, 1.01-1.82), and TSA revision or repair (OR, 2.44; CI, 1.81-3.28).

CONCLUSIONS

To our knowledge, this is the first study that directly examines the postoperative outcomes of HIV-positive patients after TSA or RTSA. As more of these patients present for surgery, surgeons should be aware that these patients might be at increased risk for certain postoperative surgical and medical complications.

Authors+Show Affiliations

Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA. Electronic address: abirambala@gmail.com.Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27117043

Citation

Bala, Abiram, et al. "Total Shoulder Arthroplasty in Patients With HIV Infection: Complications, Comorbidities, and Trends." Journal of Shoulder and Elbow Surgery, vol. 25, no. 12, 2016, pp. 1971-1979.
Bala A, Penrose CT, Visgauss JD, et al. Total shoulder arthroplasty in patients with HIV infection: complications, comorbidities, and trends. J Shoulder Elbow Surg. 2016;25(12):1971-1979.
Bala, A., Penrose, C. T., Visgauss, J. D., Seyler, T. M., Randell, T. R., Bolognesi, M. P., & Garrigues, G. E. (2016). Total shoulder arthroplasty in patients with HIV infection: complications, comorbidities, and trends. Journal of Shoulder and Elbow Surgery, 25(12), 1971-1979. https://doi.org/10.1016/j.jse.2016.02.033
Bala A, et al. Total Shoulder Arthroplasty in Patients With HIV Infection: Complications, Comorbidities, and Trends. J Shoulder Elbow Surg. 2016;25(12):1971-1979. PubMed PMID: 27117043.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Total shoulder arthroplasty in patients with HIV infection: complications, comorbidities, and trends. AU - Bala,Abiram, AU - Penrose,Colin T, AU - Visgauss,Julia D, AU - Seyler,Thorsten M, AU - Randell,Timmothy R, AU - Bolognesi,Michael P, AU - Garrigues,Grant E, Y1 - 2016/04/22/ PY - 2015/08/17/received PY - 2016/02/22/revised PY - 2016/02/24/accepted PY - 2016/4/28/pubmed PY - 2017/4/14/medline PY - 2016/4/28/entrez KW - AIDS KW - HIV KW - Total shoulder arthroplasty KW - cerebrovascular accident KW - complications KW - outcomes KW - reverse total shoulder arthroplasty SP - 1971 EP - 1979 JF - Journal of shoulder and elbow surgery JO - J Shoulder Elbow Surg VL - 25 IS - 12 N2 - BACKGROUND: Patients with human immunodeficiency virus (HIV) infection were previously at substantial risk for immunosuppression-related complications. As a result of highly active antiretroviral therapy, HIV-infected patients are living longer and are presenting for elective surgery. Outcomes in HIV-infected patients are well described for hip and knee arthroplasty but not for total shoulder arthroplasty (TSA). The purpose of this study was to examine postoperative complications of TSA in HIV-positive patients. METHODS: We queried the entire 2005 to 2012 Medicare database. Current Procedural Terminology and International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify the procedure, demographics, comorbidities, and postoperative complications. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: The query returned 2528 HIV-positive patients who underwent TSA or reverse TSA (RTSA). There was increased utilization of TSA and RTSA in this population from 2005 to 2012; 1353 patients had 2-year follow-up. These patients were slightly older and had higher prevalence of comorbidities, suggesting a sicker cohort. HIV-positive patients had alarmingly higher rates of 90-day cerebrovascular accident (OR, 35.98; CI, 30.34-42.67). HIV-positive patients had higher overall rates of broken prosthetic joints (OR, 1.72; CI, 1.20-2.47), periprosthetic infection (OR, 1.36; CI, 1.01-1.82), and TSA revision or repair (OR, 2.44; CI, 1.81-3.28). CONCLUSIONS: To our knowledge, this is the first study that directly examines the postoperative outcomes of HIV-positive patients after TSA or RTSA. As more of these patients present for surgery, surgeons should be aware that these patients might be at increased risk for certain postoperative surgical and medical complications. SN - 1532-6500 UR - https://www.unboundmedicine.com/medline/citation/27117043/Total_shoulder_arthroplasty_in_patients_with_HIV_infection:_complications_comorbidities_and_trends_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1058-2746(16)00141-5 DB - PRIME DP - Unbound Medicine ER -