Perioperative Management in Shoulder Arthroplasty

Park, Christine; Blevins, Kier; Paul, Alexandra V.; Long, Jason S.; Meyer, Lucy E.; Anakwenze, Oke

doi:10.1016/j.ocl.2022.05.003

Cited by 2 publications

(3 citation statements)

References 81 publications

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“… 21 Blood transfusions carry associated risks of allergic reaction, infection, cardiovascular dysfunction, and disease transmission. 22 Our study demonstrates a direct relationship between increasing preoperative INR levels and the risk of postoperative bleeding requiring transfusion after TSA. The prevalence of postoperative bleeding requiring transfusion was 4.7% in patients with preoperative INR ≤ 1.0 compared with 17.1% in patients with preoperative INR > 1.5.…”

Section: Discussionsupporting

confidence: 50%

“…Our findings support previous research that advanced age and female sex are associated with complications, specifically blood transfusions, after shoulder arthroplasty. 22 Our findings must be interpreted in the context of several limitations, some of which are common to the use of a large, pooled database. First, conclusions able to be drawn from the retrospective analysis of a large national database are limited by the data available.…”

Section: Figurementioning

confidence: 89%

“…Our findings support previous research that advanced age and female sex are associated with complications, specifically blood transfusions, after shoulder arthroplasty. 22 …”

Section: Discussionmentioning

confidence: 99%

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The Relationship Between Preoperative International Normalized Ratio and Postoperative Major Bleeding in Total Shoulder Arthroplasty

Zhang,

Dyer,

Earp

2024

JAAOS Glob Res Rev

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Introduction: This study aimed to assess the relationship between preoperative international normalized ratio (INR) levels and major postoperative bleeding events after total shoulder arthroplasty (TSA). Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for TSA from 2011 to 2020. A final cohort of 2405 patients with INR within 2 days of surgery were included. Patients were stratified into four groups: INR ≤ 1.0, 1.0 < INR ≤ 1.25, 1.25< INR ≤ 1.5, and INR > 1.5. The primary outcome was bleeding requiring transfusion within 72 hours, and secondary outcome variables included complication, revision surgery, readmission, and hospital stay duration. Multivariable logistic and linear regression analyses adjusted for relevant comorbidities were done. Results: Of the 2,405 patients, 48% had INR ≤ 1.0, 44% had INR > 1.0 to 1.25, 7% had INR > 1.25 to 1.5, and 1% had INR > 1.5. In the adjusted model, 1.0 < INR ≤ 1.25 (OR 1.7, 95% CI 1.176 to 2.459), 1.25 < INR ≤ 1.5 (OR 2.508, 95% CI 1.454 to 4.325), and INR > 1.5 (OR 3.200, 95% CI 1.233 to 8.302) were associated with higher risks of bleeding compared with INR ≤ 1.0. Discussion: The risks of thromboembolism and bleeding lie along a continuum, with higher preoperative INR levels conferring higher postoperative bleeding risks after TSA. Clinicians should use a patient-centered, multidisciplinary approach to balance competing risks.

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Section: Discussionsupporting

confidence: 50%

Section: Figurementioning

confidence: 89%