Agarwal, Amil R.

Chiu, Anthony K.

Cuero, Kendrick

Fuller, Samuel I.

Kreulen, Tim

Srikumaran, Umasuthan

English

George Washington University: Health Sciences Research Commons (HSRC)

Effect of Alcohol Use Disorder on Revision Rates and Perioperative Outcomes in Total Shoulder ArthroplastyAnthony K Chiu, BS1, Kendrick Cuero, BS1, Samuel I. Fuller, BS1, Amil R. Agarwal, BA1, Tim Kreulen MD2, Umasuthan Srikumaran, MD21Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC, USA2Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USAPurposeTotal shoulder arthroplasty (TSA) is widely recognized as a mainstay of surgical management for primary glenohumeral osteoarthritis. Current estimates on the incidence of TSA approximate over 50,000 shoulder replacements performed in the United States each year1. The existing literature on the impact of alcohol use disorder (AUD) in joint arthroplasty focuses largely on outcomes in hip and knee replacement2,3. The purpose of this study was to identify the association of AUD with adverse perioperative outcomes following TSA to help fill this gap in the literature. Materials and MethodsData was collected from the Mariner dataset with PearlDiver software using ICD-9, ICD-10, and CPT codes. Patients with the diagnoses of Alcohol Abuse or Alcohol Dependence were identified, excluding those in remission. Patients with underlying cirrhosis were excluded from the study. Primary outcomes for this study included 2-year revision surgery, 90-day readmission, and 90-day emergency department visit. 90-day surgical and medical complications were also investigated. Significant univariate outcomes using chi-squared tests were followed up  using multivariable logistic regression.DiscussionOur analysis reveals AUD to be independently associated with increased rates of 2-year aseptic and all-cause revision surgery, as well as 90-day readmission following primary TSA for osteoarthritis. These results expand on the existing literature regarding substance use in the context of arthroplasty. Our findings may assist orthopedic surgeons in counseling patients with AUD during the preoperative course to achieve ideal long-term results.ResultsData was collected from a total of N=59,261 patients who underwent TSA for osteoarthritis. The AUD cohort contained N=1,522 patients. Multivariable results showed that patients with AUD were more likely to undergo 2-year all-cause revision (p<0.01, OR 1.49), 2-year aseptic revision (p<0.02, OR 1.47), and 90-day hospital readmission (p<0.02, OR 1.57). Although numerous medical and surgical complications were increased on univariate analysis, these findings were not confirmed by multivariable regression.Table 1. Demographic comparison of patients undergoing TSA for primary osteoarthritis with and without a comorbid diagnosis of Alcohol Use Disorder (AUD)Table 2. Univariate analysis of long term (2-year) and 90-Day outcomesTable 3. Multivariable logistic regression analysis* of long term (2-year) and 90-Day outcomesFigure 1. Univariate analysis of long term (2-year) and 90-Day outcomes1. https://orthoinfo.aaos.org/en/treatment/shoulder-joint-replacement/2. Luo TD, Vakharia RM, Gwam CU, Zuskov A, Plate JF, Roche MW. A Matched Control Analysis on the Effects of Alcohol Use Disorder After Primary Total Knee Arthroplasty in Medicare Patients. J Am Acad Orthop Surg. 2021 Jun 15;29(12):e593-e600. 3. Horn AR, Diamond KB, Ng MK, Vakharia RM, Mont MA, Erez O. The Association of Alcohol Use Disorder with Perioperative Complications following Primary Total Hip Arthroplasty. Hip Pelvis. 2021;33(4):231-238.

Effect of Alcohol Use Disorder on Revision Rates and Perioperative Outcomes in Total Shoulder Arthroplasty

https://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?article=1123&context=gw_research_showcase

Effect of Alcohol Use Disorder on Revision Rates and Perioperative Outcomes in Total Shoulder Arthroplasty

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