Preoperative diagnosis of atrial fibrillation significantly increased the risk of two-year total implant-related complications (RR 1.19) and mortality (RR 2.37) following primary total shoulder arthroplasty.
Cohort (n=7,728)
Yes
Does a preoperative diagnosis of atrial fibrillation increase the risk of postoperative complications in patients undergoing primary total shoulder arthroplasty?
Preoperative atrial fibrillation is a significant risk factor for both short- and long-term medical and implant-related complications following primary total shoulder arthroplasty.
Effect estimate: RR 1.19 (95% CI 1.04-1.37)
Absolute Event Rate: 10.17% vs 8.54%
p-value: p=0.014
Background: Atrial fibrillation (AF) is a common cardiac comorbidity associated with increased risk of bleeding and complications following surgery. Few studies have evaluated the impact of preoperative diagnosis of AF on complications following primary total shoulder arthroplasty (TSA). The purpose of this study is to evaluate the risk of 90-day and two-year postoperative medical and implant-related complications in patients undergoing TSA with a diagnosis of AF. Methods: A multicentre database, TriNetX (TriNetX, LLC, Cambridge, MA, USA), was queried for patients who underwent primary TSA between 2013 and 2023. After exclusion criteria, patients were divided into two cohorts: those diagnosed with a preoperative diagnosis of AF prior to TSA and those without a preoperative diagnosis of AF (non-AF). The AF and non-AF cohorts were propensity-matched in a 1:1 ratio. Medical complications included sepsis, infection, stroke, pneumonia, renal failure, myocardial infarction (MI), venous thromboembolism (VTE), hemorrhage, blood transfusion, wound dehiscence, superficial surgical site infection (SSI), deep SSI, organ/space SSI, readmission, and mortality. Implant-related complications include revision TSA, periprosthetic joint infection (PJI), periprosthetic fracture, dislocation, and mechanical loosening. Results: Three thousand eight hundred sixty-four patients were included in each cohort after propensity matching, accounting for any significant differences in patient demographics or comorbidities. Within 90 days following primary TSA, patients with AF showed a significantly increased risk of stroke, pneumonia, and VTE compared to the non-AF cohort (p < 0.05). Within two years following TSA, patients with AF showed a significantly increased risk of stroke, pneumonia, VTE, MI, renal failure, blood transfusion, mortality, total implant-related complication rate, and PJI compared to the non-AF cohort (p < 0.05). Conclusion: Preoperative diagnosis of AF is associated with an increased risk of 90-day and two-year medical and implant-related complications following primary TSA. Surgeons should be aware of these risks to better optimize their patients.
Muthusamy et al. (Mon,) conducted a cohort in Primary Total Shoulder Arthroplasty (n=7,728). Preoperative diagnosis of atrial fibrillation vs. No preoperative diagnosis of atrial fibrillation was evaluated on Total implant-related complication rate at 2 years (RR 1.19, 95% CI 1.04-1.37, p=0.014). Preoperative diagnosis of atrial fibrillation significantly increased the risk of two-year total implant-related complications (RR 1.19) and mortality (RR 2.37) following primary total shoulder arthroplasty.