Examining the effects of modifiable risk factors on postoperative outcomes after total shoulder arthroplasty

Background/Purpose: Modifiable risk factors can impact the surgical outcome after total shoulder arthroplasty (TSA), yet this topic has not been adequately explored. We sought to quantify the effects of common modifiable patient risk factors on the postoperative outcomes and complications in patients who underwent total shoulder arthroplasty (TSA). Methods: Data was collected from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) 2006-2016 database for patients undergoing a principle procedure of total shoulder arthroplasty using current procedural terminology (CPT) code 23,472. Modifiable risk factors were defined as patients’ smoking status, use of alcohol, diabetes, hypertension, obesity, recent loss of >10% body weight, malnutrition, and anemia. Outcomes of interest included discharge destination, surgical site infection, wound complications, and hematologic complications. Results: There were 14,478 adult patients undergoing total shoulder arthroplasty in the NSQIP database. The majority of patients were Caucasian (83.9%), female (56.2%), and between the ages of 61 and 80 (70.1%). Malnutrition was the only preoperative modifiable variable found to be significantly associated with outcomes. Patients with malnutrition had an increased risk of nonroutine discharge status (OR = 3.12) and hematologic complications (OR = 4.58). Other modifiable risk factors (smoking status, use of alcohol, diabetes, hypertension, obesity, recent loss of >10% body weight, and anemia) analyzed were not significantly associated with outcomes. Conclusions: Malnutrition is associated with an approximately 3-time increased likelihood of nonroutine discharge and 5-time increased likelihood of hematologic complications after TSA. Surgeons should have heightened awareness for potential complications in these patients. While surgeons should continue to counsel their patients on all modifiable risk factors, they may not expect to see differences in the clinical outcomes following TSA. Level of Evidence: Level IV, prognostic study, retrospective case series.