Malnutrition (low preoperative albumin concentration) is associated with shoulder arthroplasty complications

Malnutrition: a marker for increased complications, mortality, and length of stay after total shoulder arthroplasty.

These authors searched the American College of Surgeons National Surgical Quality Improvement Program database was queried for TSA cases from 2005 to 2013. 

They compared rates of postoperative complications for patients with and without malnutrition (defined as preoperative albumin concentration of <3.5 g/dL.) among 1681 patients with preoperative albumin measurements available 7.6% of which were malnourished.

Propensity-adjusted multivariable logistic regression demonstrated that malnutrition was significantly associated with postoperative transfusion (odds ratio, 2.49), extended LOS (odds ratio, 1.69), and death within 30 days of surgery (odds ratio, 18.09).

Comment: From the table below, it can be seen that the patients with low albumin were sicker in many different regards. 

In that shoulder arthroplasty is an elective procedure, we wonder why surgery was performed on so many patients with poor health. In view of these data, we are informed that non-operative management requires serious consideration in these individuals.

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Cardiovascular safety of non-steroidal anti-inflammatory drugs for arthritis, NSAIDS

The British Medical Journal recently published a network meta-analysis to analyze the evidence on cardiovascular safety of non-steroidal anti-inflammatory medications. These are medications that are commonly used to manage the symptoms of arthritis. They looked at the rates of myocardial infarction (heart attacks), as well as strokes, death from cardiovascular disease, and death from any causes. They included 31 randomized controlled trials with data from over 100,000 patients. Patients included those taking naproxen (Aleve), ibuprofen (Advil), diclofenac (Voltaren), celecoxib (Celebrex), etoricoxib (Arcoxia), rofecoxib (Vioxx), lumiracoxib (Prexige), or placebo (a pill with no biological activity). Compared with placebo, rofecoxib was associated with the highest risk of myocardial infarction, followed by lumiracoxib. Ibuprofen was associated with the highest risk of stroke, followed by diclofenac. Etoricoxib and diclofenac were associated with the highest risk of cardiovascular death. However, none of these drugs appeared to be free of cardiovascular risk. Among them, naproxen seemed to be the safest. While this study does not indicate that these medications should be avoided, it does suggest that moderate and intermittent use may be advisable to minimize the risk.
See also Drugs for arthritis: the good and the bad and our post on the relative safety of these medications.

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You may be interested in some of our most visited web pages including: shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.

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