The association of alcohol use disorder with revision rates and post-operative complications in total shoulder arthroplasty

Abstract

Background

Alcohol use disorder (AUD) is the most prevalent substance use disorder in the United States. However, the current literature on AUD as a preoperative risk factor for Total Shoulder Arthroplasty (TSA) outcomes is limited. The purpose of this study was to identify the association of AUD with revision rates and 90-day postoperative complications in TSA.

Methods

A retrospective study was conducted using the PearlDiver database. Patients diagnosed with AUD were identified. Patients in remission or with underlying cirrhosis were excluded. Outcomes included 2-year revision, 90-day readmission, 90-day emergency, and 90-day post-operative medical complications. Analysis was performed with univariate chi-squared tests followed by multivariable logistic regression.

Results

A total of 59,261 patients who underwent TSA for osteoarthritis were identified, with 1522 patients having a diagnosis of AUD. Multivariable logistic regression showed that patients with AUD were more likely to undergo 2-year all-cause revision (OR = 1.49, p = 0.007), 2-year aseptic revision (OR = 1.47, p = 0.014), 90-day hospital readmission (OR = 1.57, p = 0.015), and 90-day transient mental disorder (OR = 2.13, p = 0.026).

Conclusions

AUD is associated with increased rates of 2-year revision surgery, as well as 90-day readmission and 90-day transient mental disorder following primary TSA for osteoarthritis. These findings may assist orthopedic surgeons in counseling patients with AUD during the pre-operative course.

Keywords

Alcohol use disorder total shoulder arthroplasty revision complications retrospective study

Get full access to this article

View all access options for this article.

References

Day

Lau

Ong

, et al. Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015. J Shoulder Elbow Surg 2010; 19: 1115–1120.

Best

Aziz

Wilckens

, et al. Increasing incidence of primary reverse and anatomic total shoulder arthroplasty in the United States. J Shoulder Elbow Surg 2021; 30: 1159–1166.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth Ed (DSM-5). Arlington, VA: American Psychiatric Publishing Inc., 2013. DOI: 10.1176/appi.books.9780890425596.

Harris

Reeder

Ellerbe

, et al. Preoperative alcohol screening scores: association with complications in men undergoing total joint arthroplasty. J Bone Joint Surg Am 2011; 93: 321–327.

McDonald

Yates

Durrand

, et al. Exploring patient attitudes to behaviour change before surgery to reduce peri-operative risk: preferences for short- vs. long-term behaviour change. Anaesthesia 2019; 74: 1580–1588.

National Institute on Alcohol abuse and Alcoholism: Drinking Levels Defined. NIAAA website. Accessed March 16, 2021. https://www-niaaa-nih-gov.proxygw.wrlc.org/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking

Grant

Goldstein

Saha

, et al. Epidemiology of DSM-5 alcohol use disorder: results from the National Epidemiologic Survey on alcohol and related conditions III. JAMA Psychiatry 2015; 72: 757–766.

Best

Buller

Gosthe

, et al. Alcohol misuse is an independent risk factor for poorer post-operative outcomes following primary total hip and total knee arthroplasty. J Arthroplasty 2015; 30: 1293–1298.

Bozic

Lau

Ong

, et al. Risk factors for early revision after primary TKA in Medicare patients. Clin Orthop Relat Res 2014; 472: 232–237.

10.

Radtke

Tetzlaff

Vaske

, et al. Arthroplasty-center related retrospective analysis of risk factors for periprosthetic joint infection after primary and after revision total hip arthroplasty. Technol Health Care 2016; 24: 721–728.

11.

Luo

Vakharia

Gwam

, et al. 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; 29: e593–e600.

12.

Leschinger

Raiss

Loew

, et al. Total shoulder arthroplasty: risk factors for intraoperative and post-operative complications in patients with primary arthritis. J Shoulder Elbow Surg 2017; 26: e71–e77.

13.

Nassis

Imas

Roth

, et al. A matched-control analysis on the effects of alcohol use disorder following primary reverse shoulder arthroplasty. J Orthop 2021; 24: 186–189.

14.

Ashraf

Swiggett

Golub

, et al. The association of alcohol use disorder with perioperative outcomes after primary total shoulder arthroplasty for glenohumeral osteoarthritis: a retrospective matched cohort study. Semin Arthroplasty 2022; 32: 327–333.

15.

Ponce

Oladeji

Raley

, et al. Analysis of perioperative morbidity and mortality in shoulder arthroplasty patients with preexisting alcohol use disorders. J Shoulder Elbow Surg 2015; 24: 167–173.

16.

Deleuran

Vilstrup

Overgaard

, et al. Cirrhosis patients have increased risk of complications after hip or knee arthroplasty. Acta Orthop 2015; 86: 108–113.

17.

Tiberi

Hansen

El-Abbadi

, et al. Increased complication rates after hip and knee arthroplasty in patients with cirrhosis of the liver. Clin Orthop Relat Res 2014; 472: 2774–2778.

18.

Shih

Cheng

Chang

, et al. Total knee arthroplasty in patients with liver cirrhosis. J Bone Joint Surg Am 2004; 86: 335–341.

19.

Jiang

Schairer

Bozic

. Increased rates of periprosthetic joint infection in patients with cirrhosis undergoing total joint arthroplasty. Clin Orthop Relat Res 2014; 472: 2483–2491.

20.

Marmotti

Messina

Cykowska

, et al. Periprosthetic osteolysis: a narrative review. J Biol Regul Homeost Agents 2020; 34: 405–417.

21.

Chen

Yan

, et al. Alcohol induces cellular senescence and impairs osteogenic potential in bone marrow-derived mesenchymal stem cells. Alcohol Alcohol 2017; 52: 289–297.

22.

Yoon

Kim

Shin

, et al. Alcohol intake and the risk of osteonecrosis of the femoral head in Japanese populations: a dose-response meta-analysis of case-control studies. Clin Rheumatol 2017; 36: 2517–2524.

23.

Nordeck

Welsh

Schwartz

, et al. Rehospitalization and substance use disorder (SUD) treatment entry among patients seen by a hospital SUD consultation-liaison service. Drug Alcohol Depend 2018; 186: 23–28.

24.

Chavez

Liu

Tefft

, et al. The association between unhealthy alcohol use and acute care expenditures in the 30 days following hospital discharge among older Veterans Affairs Patients with a medical condition. J Behav Health Serv Res 2017; 44: 602–624.

25.

Urish

Qin

, et al. Predictors and cost of readmission in total knee arthroplasty. J Arthroplasty 2018; 33: 2759–2763.

26.

Forlizzi

Puzzitiello

Hart

, et al. Predictors of poor and excellent outcomes after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31: 294–301.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.01 MB