Analysis of perioperative morbidity and mortality in shoulder arthroplasty patients with preexisting alcohol use disorders.
5.4% of adults have been classified as heavier drinkers (women who drink, on average, more than 7 drinks per week; men who drink, on average, more than 14 drinks per week).
These authors used the Nationwide Inpatient Sample, to perform a retrospective cohort study of 422,371 patients undergoing total shoulder arthroplasty or hemiarthroplasty between January 1, 2002, and December 31, 2011. Alcohol use disorder was identified with the following ICD-9-CM codes: 303 (acute alcohol intoxication), 303.9 (unspecified alcohol dependence), 305 (alcohol abuse), and 291 (alcohol-induced mental disorders).
The adverse outcomes for patients with codes for alcohol use disorders were compared to those for patients without these codes.
Patients undergoing shoulder arthroplasty with a preexisting alcohol use disorder had a greater likelihood of death, pneumonia, deep venous thrombosis, acute renal failure, transfusion, prolonged length of stay, and nonroutine discharge irrespective of age, gender, race, and other medical comorbidities. Patients with alcohol use disorder experienced a complication rate of 25.4% compared with 10.9% in those without.
Patients with alcohol use disorder tended to be younger (62 11 years vs 69 11 years), males (63% vs 39%, and of African American descent (4.7% vs 3.1%). They tended to have either Medicaid insurance (8.8% vs 2.5%0) or private insurance (34% vs 26%), and a lower median household income. Importantly, patients with alcohol use disorder tended to have hemiarthroplasty at a significantly higher rate (64% and 40% respectively; P < .001).
Comment: In general, shoulder arthroplasty is an elective procedure. Patients with important risk factors for complications, such as alcohol use disorder, need to advised of the risks and placed on a program to reduce or eliminate the risk as an indication of their commitment to an optimal result. Patients with alcohol use disorder are less healthy overall, have reduced immune function, are less likely to be compliant with postoperative rehabilitation, and are at greater risk for falls.
The authors of this paper did not compare the shoulder diagnoses between the alcohol use disorder group and the control group. The higher rate of hemiarthroplasty in the former suggests that a higher percentage of patients may have had a diagnosis of fracture in which case the surgery is not elective and there may not be time for a program of risk abatement.
Patients undergoing shoulder arthroplasty with a preexisting alcohol use disorder had a greater likelihood of death, pneumonia, deep venous thrombosis, acute renal failure, transfusion, prolonged length of stay, and nonroutine discharge irrespective of age, gender, race, and other medical comorbidities. Patients with alcohol use disorder experienced a complication rate of 25.4% compared with 10.9% in those without.
Patients with alcohol use disorder tended to be younger (62 11 years vs 69 11 years), males (63% vs 39%, and of African American descent (4.7% vs 3.1%). They tended to have either Medicaid insurance (8.8% vs 2.5%0) or private insurance (34% vs 26%), and a lower median household income. Importantly, patients with alcohol use disorder tended to have hemiarthroplasty at a significantly higher rate (64% and 40% respectively; P < .001).
Comment: In general, shoulder arthroplasty is an elective procedure. Patients with important risk factors for complications, such as alcohol use disorder, need to advised of the risks and placed on a program to reduce or eliminate the risk as an indication of their commitment to an optimal result. Patients with alcohol use disorder are less healthy overall, have reduced immune function, are less likely to be compliant with postoperative rehabilitation, and are at greater risk for falls.
The authors of this paper did not compare the shoulder diagnoses between the alcohol use disorder group and the control group. The higher rate of hemiarthroplasty in the former suggests that a higher percentage of patients may have had a diagnosis of fracture in which case the surgery is not elective and there may not be time for a program of risk abatement.
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