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Patients With Chronic Obstructive Pulmonary Disease Are at Higher Risk for Pneumonia, Septic Shock, and Blood Transfusions After Total Shoulder Arthroplasty.
Clin Orthop Relat Res 2019; 477(2):416-423CO

Abstract

BACKGROUND

Chronic obstructive pulmonary disease (COPD) has been associated with several complications after surgery, including pneumonia, myocardial infarction, septic shock, and mortality. To the authors' knowledge, there has been no work analyzing the impact of COPD on complications after total shoulder arthroplasty (TSA). Although previous work has elucidated the complications COPD has on TKA and THA, extrapolating the results of lower extremity arthroplasty to TSA may prove to be inaccurate. Compared with lower extremity arthroplasty, TSA is a relatively new procedure that has only recently gained popularity. Therefore, this study seeks to elucidate COPD's effects on complications in TSA specifically so that postoperative care can be tailored for these patient populations. Assessing these patients may enable surgeons to implement preoperative precautionary measures to prevent serious adverse events in these patients.

QUESTIONS/PURPOSES

What serious postoperative complications are patients with COPD at risk for within the 30-day postoperative period after TSA?

METHODS

The American College of Surgeons National Surgical Quality Improvement Program® (ACS-NSQIP) database was queried to identify 14,494 patients who had undergone TSA between 2005 and 2016, excluding patients who had undergone hemiarthroplasties of the shoulder and revision shoulder arthroplasties. The ACS-NSQIP database was utilized in this study for the comprehensive preoperative and postoperative medical histories it provides for each patient for 274 characteristics. Among the 14,494 patients undergoing TSA, 931 (6%) patients who had a history of COPD were identified, and the two cohorts-COPD and non-COPD-were analyzed for differences in their demographic factors, comorbidities, and acute complications occurring within 30 days of their procedure. Univariate analyses were utilized to assess differences in the prevalence of demographic features, comorbidities, and perioperative/postoperative outcomes after surgery. Multivariate regression analyses were used to assess COPD as an independent risk factor associated with complications.

RESULTS

COPD is an independent risk factor for three complications after TSA: pneumonia (odds ratio [OR], 2.793; 95% confidence interval [CI], 1.426-5.471; p = 0.003), bleeding resulting in transfusion (OR, 1.577; 95% CI, 1.155-2.154; p = 0.004), and septic shock (OR, 9.259; 95% CI, 2.140-40.057; p = 0.003).

CONCLUSIONS

In light of the increased risk of these serious complications, surgeons should have a lower threshold of suspicion for infection in patients with COPD after TSA so that adequate measures can be taken before developing severe infectious complications including pneumonia and septic shock. Surgeons may also consider administering tranexamic acid in patients with COPD undergoing TSA to reduce the amount of blood transfusions necessary. Future work through randomized control trials analyzing (1) the effectiveness of more aggressive infection prophylaxis in decreasing the risk of pneumonia/septic shock; and (2) the use of tranexamic acid in decreasing blood transfusion requirements in patients with COPD undergoing TSA is warranted.

LEVEL OF EVIDENCE

Level III, therapeutic study.

Authors+Show Affiliations

R. Lee, D. Lee, I. S. Mamidi, The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA W. V. Probasco, J. H. Heyer, R. Pandarinath, Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30664604

Citation

Lee, Ryan, et al. "Patients With Chronic Obstructive Pulmonary Disease Are at Higher Risk for Pneumonia, Septic Shock, and Blood Transfusions After Total Shoulder Arthroplasty." Clinical Orthopaedics and Related Research, vol. 477, no. 2, 2019, pp. 416-423.
Lee R, Lee D, Mamidi IS, et al. Patients With Chronic Obstructive Pulmonary Disease Are at Higher Risk for Pneumonia, Septic Shock, and Blood Transfusions After Total Shoulder Arthroplasty. Clin Orthop Relat Res. 2019;477(2):416-423.
Lee, R., Lee, D., Mamidi, I. S., Probasco, W. V., Heyer, J. H., & Pandarinath, R. (2019). Patients With Chronic Obstructive Pulmonary Disease Are at Higher Risk for Pneumonia, Septic Shock, and Blood Transfusions After Total Shoulder Arthroplasty. Clinical Orthopaedics and Related Research, 477(2), pp. 416-423. doi:10.1097/CORR.0000000000000531.
Lee R, et al. Patients With Chronic Obstructive Pulmonary Disease Are at Higher Risk for Pneumonia, Septic Shock, and Blood Transfusions After Total Shoulder Arthroplasty. Clin Orthop Relat Res. 2019;477(2):416-423. PubMed PMID: 30664604.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patients With Chronic Obstructive Pulmonary Disease Are at Higher Risk for Pneumonia, Septic Shock, and Blood Transfusions After Total Shoulder Arthroplasty. AU - Lee,Ryan, AU - Lee,Danny, AU - Mamidi,Ishwarya S, AU - Probasco,William V, AU - Heyer,Jessica H, AU - Pandarinath,Rajeev, PY - 2020/02/01/pmc-release PY - 2019/1/22/entrez PY - 2019/1/22/pubmed PY - 2019/11/19/medline SP - 416 EP - 423 JF - Clinical orthopaedics and related research JO - Clin. Orthop. Relat. Res. VL - 477 IS - 2 N2 - BACKGROUND: Chronic obstructive pulmonary disease (COPD) has been associated with several complications after surgery, including pneumonia, myocardial infarction, septic shock, and mortality. To the authors' knowledge, there has been no work analyzing the impact of COPD on complications after total shoulder arthroplasty (TSA). Although previous work has elucidated the complications COPD has on TKA and THA, extrapolating the results of lower extremity arthroplasty to TSA may prove to be inaccurate. Compared with lower extremity arthroplasty, TSA is a relatively new procedure that has only recently gained popularity. Therefore, this study seeks to elucidate COPD's effects on complications in TSA specifically so that postoperative care can be tailored for these patient populations. Assessing these patients may enable surgeons to implement preoperative precautionary measures to prevent serious adverse events in these patients. QUESTIONS/PURPOSES: What serious postoperative complications are patients with COPD at risk for within the 30-day postoperative period after TSA? METHODS: The American College of Surgeons National Surgical Quality Improvement Program® (ACS-NSQIP) database was queried to identify 14,494 patients who had undergone TSA between 2005 and 2016, excluding patients who had undergone hemiarthroplasties of the shoulder and revision shoulder arthroplasties. The ACS-NSQIP database was utilized in this study for the comprehensive preoperative and postoperative medical histories it provides for each patient for 274 characteristics. Among the 14,494 patients undergoing TSA, 931 (6%) patients who had a history of COPD were identified, and the two cohorts-COPD and non-COPD-were analyzed for differences in their demographic factors, comorbidities, and acute complications occurring within 30 days of their procedure. Univariate analyses were utilized to assess differences in the prevalence of demographic features, comorbidities, and perioperative/postoperative outcomes after surgery. Multivariate regression analyses were used to assess COPD as an independent risk factor associated with complications. RESULTS: COPD is an independent risk factor for three complications after TSA: pneumonia (odds ratio [OR], 2.793; 95% confidence interval [CI], 1.426-5.471; p = 0.003), bleeding resulting in transfusion (OR, 1.577; 95% CI, 1.155-2.154; p = 0.004), and septic shock (OR, 9.259; 95% CI, 2.140-40.057; p = 0.003). CONCLUSIONS: In light of the increased risk of these serious complications, surgeons should have a lower threshold of suspicion for infection in patients with COPD after TSA so that adequate measures can be taken before developing severe infectious complications including pneumonia and septic shock. Surgeons may also consider administering tranexamic acid in patients with COPD undergoing TSA to reduce the amount of blood transfusions necessary. Future work through randomized control trials analyzing (1) the effectiveness of more aggressive infection prophylaxis in decreasing the risk of pneumonia/septic shock; and (2) the use of tranexamic acid in decreasing blood transfusion requirements in patients with COPD undergoing TSA is warranted. LEVEL OF EVIDENCE: Level III, therapeutic study. SN - 1528-1132 UR - https://www.unboundmedicine.com/medline/citation/30664604/Patients_With_Chronic_Obstructive_Pulmonary_Disease_Are_at_Higher_Risk_for_Pneumonia_Septic_Shock_and_Blood_Transfusions_After_Total_Shoulder_Arthroplasty_ L2 - http://Insights.ovid.com/pubmed?pmid=30664604 DB - PRIME DP - Unbound Medicine ER -