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Patients with epilepsy had high risk for post-shoulder arthroplasty complications
Surgeons should be cautious performing shoulder arthroplasty in patients with epilepsy.
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After shoulder arthroplasty, patients with epilepsy were at a higher risk for early postoperative complications and increased resource use, according to study results.
“Patients with epilepsy have a higher risk for postoperative complications and are more likely to have prolonged hospital stays and may be less likely able to go home than your typical shoulder replacement patient,” Brent A. Ponce, MD, associate professor at the University of Alabama at Birmingham, told Orthopedics Today.
Postoperative adverse events
Using the National Inpatient Sample (NIS) for 2002 to 2011, Ponce and his colleagues identified 422,371 adults undergoing shoulder arthroplasty. Of these patients 3,714 had an epilepsy diagnosis. Multivariable logistic regression modeling was used to perform comparisons of perioperative outcomes with and without epilepsy.
Results showed postoperative adverse events, including mechanical ventilation, gastrointestinal complication, deep venous thrombosis, pneumonia, post-hemorrhagic anemia and transfusion and acute renal failure, were more likely to occur in the patients with epilepsy.
Consult specialists
Patients with epilepsy had increased odds for prolonged hospital stay and non-routine discharge, researchers noted. Ponce said he was surprised by these findings as he was unaware of the correlation between epilepsy medicines and increased bleeding or immunosuppressive adverse events, and that chronic epilepsy medications could cause lung disease.
“The clinical significance for that is the numerous epilepsy-associated medications increase the risk for infections. They also increase the risk for bleeding, in addition to increasing the risk for chronic lung disease,” he said.
“These are complex patients and it is not just a diagnosis where they are on a single medication. It is important to have a more holistic picture along with having increased caution to preoperatively ‘tune’ these patients up. Then, postoperatively, have a low threshold to consult appropriate specialists to help assure that these patients are adequately managed to help avoid and proactively manage early complications,” he said.
Ponce noted these results represent a good introduction to an important topic that affects fewer than 1% of patients who undergo shoulder arthroplasty.
“I think future steps to take are to see if we can help answer whether it is the duration that they have been diagnosed with epilepsy, the number of medications that they are on or if there are other critical variables that we have not identified that impact outcomes,” Ponce said.
He also hopes future research will help confirm and validate these findings considering there are limitations with the NIS database used in this investigation. – by Casey Tingle
- Reference:
- Churchill J, et al. Orthopedics. 2016;doi:10.3928/01477447-20160714-02.
- For more information:
- Brent A. Ponce, MD, can be reached at Division of Orthopedic Surgery, University of Alabama at Birmingham, 1313 S. 13th St., Suite 203, Birmingham, AL 35205; email: bponce@uabmc.edu.
Disclosure: Ponce reports no relevant financial disclosures.