COVID-19 infection prior to shoulder arthroplasty may increase risk of complications
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Key takeaways:
- COVID-19 within 30 days prior to shoulder arthroplasty may increase risk of several postoperative complications.
- Patients with recent COVID-19 infections may benefit from postponing elective TSA procedures.
Results showed COVID-19 diagnosis prior to total shoulder arthroplasty was associated with increased risk of sepsis, ED visits, readmissions, periprosthetic fractures, wound infections, thrombosis and revisions at 60 days postoperatively.
Researchers used the TriNetX database to perform a retrospective cohort comparison of 63,768 patients (mean age, 72 years) who underwent TSA between Jan. 1, 2018, and July 1, 2023. Among the cohort, 7,118 patients (11.08%) were diagnosed with COVID-19 within 30 days prior to surgery. Researchers then assessed two propensity-matched cohorts of 6,982 patients with vs. without COVID-19 prior to TSA.
Patients with a COVID-19 diagnosis prior to TSA had 1.96 times the odds of sepsis (P = .0005), 1.42 times the odds of superficial wound infection (P = .0032), 1.42 times the odds of deep vein thrombosis (P < .0001) and 1.52 times the odds of pulmonary embolism (P = .0001) compared with patients without COVID-19 prior to TSA within 60 days postoperatively.
In addition, patients with a COVID-19 diagnosis prior to TSA had 1.10 times the odds of ED visits (P = .0249), 1.79 times the odds of readmission (P < .0001), 3.10 times the odds of periprosthetic fracture (P < .0001) and 2.87 times the odds of revision (P < .0001) compared with patients without COVID-19 prior to TSA within 60 days postoperatively.
“There may be significant benefit to closer monitoring and greater preventive measures to reduce the occurrence of postoperative complications in this setting,” the researchers wrote in the study. “In addition, patients may benefit from postponing elective TSA procedures in the setting of a recent COVID-19 infection.”
Perspective
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COVID-19 played a huge role during the past several years on elective joint surgeries. There was a significant amount of uncertainty on how to appropriately manage these patients and when to operate on them in relation to a positive preoperative COVID test.
This study investigated the impact of COVID-19 on patients who underwent total shoulder arthroplasty. The researchers analyzed a dataset of TSA patients and compared the demographic characteristics and complications between COVID-19-positive and COVID-19-negative patients.
COVID-19-positive patients had higher odds of experiencing certain complications within 60 days of TSA, including sepsis, superficial wound infections, deep venous thromboembolism, pulmonary embolism, ED visits, hospital admissions, periprosthetic fracture and revision surgery.
These findings suggest that COVID-19 infection may increase the risk of specific complications following TSA. Therefore, it is important to closely monitor and implement preventive measures in TSA patients with a recent COVID-19 diagnosis.
In addition, the study highlights the potential benefit of postponing elective TSA procedures in patients with a recent COVID-19 infection. Patients are often eager to get their shoulder out of pain, but we should do our due diligence and share potential risks of proceeding too soon after COVID-19 infection. Further research is needed to better understand the risk factors and develop guidelines for managing high-risk patients.
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