Patients With Chronic Obstructive Pulmonary Disease Are at Higher Risk for Pneumonia, Septic Shock, and Blood Transfusions After Total Shoulder Arthroplasty

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).Each author certifies that neither he or she, nor any member of his or her immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Trends in total shoulder arthroplasty from 2005 to 2018: lower complications rates and shorter lengths of stay despite patients with more comorbidities

“… 19 , 29 Diabetes has been shown to be an independent risk factor for wound complications, stroke, renal failure, and sepsis after SA. 18 , 31 Similarly, Lee et al 26 found COPD to be an independent risk factor for pneumonia and septic shock among patients undergoing TSA.…”

Mortality among patients undergoing orthopedic surgeries and admitted to the ICU

“…For instance, Lee et al expressed that patients that underwent orthopedic surgeries and suffering from COPD develop severe complications as the need for blood transfusion, septic shock, and anemia which usually require postoperative ICU admission. 13 Klasan et al also supported those same findings in a patient-matched study of lower-limb orthopedics. 14 Friedman et al also reported that having benign heart murmurs was an independent significant factor for predicting ICU admissions after orthopedic surgeries.…”

Incidence, Patient-Related Risk Factors, and Outcomes of Postoperative Pneumonia after Cholecystectomy: A Population-Based Cohort Study

“…The first independent risk factor of postcholecystectomy pneumonia was preoperative chronic obstructive pulmonary disease, which is the most significant predictor in our study. Several studies have examined the association between chronic obstructive pulmonary disease and postoperative pneumonia [ 13 , 15 , 16 ]. Results about whether chronic obstructive pulmonary disease is correlated with postoperative pulmonary complications are controversial.…”