Shoulder Arthroplasty Outcomes in Patients With Multiple Reported Drug Allergies

Abstract

Background:The presence of multiple allergies has been correlated with worse outcomes for patients undergoing hip and knee arthroplasty, but the effect of allergies has not yet been elucidated with respect to shoulder arthroplasty.Purpose/Hypothesis:The purpose of this study is to identify any discrepancies in shoulder arthroplasty outcomes with respect to reported drug allergies. We hypothesized that patients with multiple drug allergies would have inferior outcomes.Study Design:Cohort study; Level of evidence, 3.Methods:Included in the analysis were a single surgeon’s cases between 2009 and 2014 of primary total shoulder arthroplasty with a minimum of 180 days of follow-up. Cases with fracture as the indication were excluded. Preoperative and postoperative metrics included visual analog scale (VAS) for pain, forward flexion range of motion, and Simple Shoulder Test (SST) results, and postoperative patient satisfaction scores were also collected. Chi-square and 1-way analysis of variance with Tukey post hoc analyses were performed when appropriate.Results:A total of 98 patients were included (no allergies, n = 51; single allergy, n = 21; multiple allergies, n = 26). The proportion of females was greater with increasing number of allergies (no allergies, 31%; single allergies, 47%; multiple allergies, 88%; Pearson χ2 = 22.5; P < .0001). Both preoperatively and postoperatively, no difference was found between cohorts with respect to SST score, VAS score, or forward flexion. There was also no difference in postoperative satisfaction between cohorts. No difference between cohorts was identified when comparing the pre- to postoperative change in SST scores, VAS scores, or forward flexion.Conclusion:The presence of single or multiple allergies is not correlated with worse outcomes after primary anatomic total shoulder arthroplasty.

Patient-Reported Allergies Do Not Predict Poorer PROMIS Function, Pain, and Depression Scores Following Foot and Ankle Surgery

“…Consistent with prior reports, our study did show that women more commonly had self-reported allergies than men. 11,15 On closer inspection of the published data, our inability to identify differences in foot and ankle outcomes based on PRAs may actually be more consistent with the commonly cited hip and knee arthroplasty studies on this topic. Comparing hip and knee arthroplasty patients without PRAs to patients with at least 1 PRA, Otero et al 12 12 To understand if the changes in MCS and PCS scores from Otero et al 12 were clinically relevant, we compared them to published data on the minimal clinically important difference (MCID) for the same outcome measures in hip arthroplasty patients.…”

“…Consistent with prior reports, our study did show that women more commonly had self-reported allergies than men. 11,15…”

“…3,5,9,12 However, a similarly designed study on shoulder replacement patients found no difference in outcomes or clinical motion between patients with or without PRAs. 15 No study has probed whether PRAs affect foot and ankle patient-reported outcomes. Here, we did not find any differences in PROMIS physical function, pain interference, or depression scores following foot and ankle surgery in patients with or without PRAs.…”

“…3,5,9,12 However, the data on PRAs as a risk factor for worse outcomes is conflicting as a similar study of patients undergoing shoulder arthroplasty failed to link PRAs to poorer outcomes or shoulder motion after total shoulder arthroplasty. 15 In addition, none of the aforementioned studies on PRAs in orthopedics used modern outcomes tools such as the Patient Reported Outcome Measurement Information System (PROMIS) that can efficiently capture outcome data from various domains without the obstacles inherent to traditional outcomes instruments such as responder burden and incomplete questionnaires. 1 Further, no study to our knowledge has assessed the role of PRAs in foot and ankle patients to determine if PRAs may represent an identifiable risk factor in foot and ankle surgery.…”

Patient-Reported Allergies, a Marker of Preoperative Pain and Disability in Elective Spine Surgery

“…A recent study by Rosenthal et al revealed that the presence of one or more self-reported allergies did not correlate with worse function, satisfaction, pain, or range of motion postoperatively. 4 On the contrary, another recent study demonstrated that a greater number of patient-reported allergies correlated with severe postoperative pain in patients undergoing elective total shoulder arthroplasty. 5 To date, there are very few studies in spine surgery that examine patient allergy lists, and their corresponding function and pain scores.…”