Iron deficiency anemia is associated with increased medical and implant-related complications and length of stay for patients undergoing total shoulder arthroplasty

Teja Polisetty; Dylan Cannon; Gagan Grewal; Rushabh M Vakharia; Austin Vegas; Jonathan C Levy

doi:10.1016/j.jse.2022.11.005

Iron deficiency anemia is associated with increased medical and implant-related complications and length of stay for patients undergoing total shoulder arthroplasty

J Shoulder Elbow Surg. 2023 May;32(5):e200-e205. doi: 10.1016/j.jse.2022.11.005. Epub 2022 Dec 15.

Authors

Teja Polisetty¹, Dylan Cannon², Gagan Grewal³, Rushabh M Vakharia⁴, Austin Vegas¹, Jonathan C Levy⁵

Affiliations

¹ Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA.
² Department of Orthopaedic Surgery, University of Oklahoma, Oklahoma City, OK, USA.
³ Department of Orthopaedic Surgery, Larkin Community Hospital, South Miami, FL, USA.
⁴ Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA.
⁵ Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA. Electronic address: Jonlevy123@yahoo.com.

PMID: 36529381
DOI: 10.1016/j.jse.2022.11.005

Abstract

Background: Iron deficiency anemia (IDA) is associated with decreased bone mineral density and osteoporosis; however, studies investigating the effects of IDA in patients undergoing primary total shoulder arthroplasty (TSA) have not been well studied. The purpose of this study is to utilize a nationwide administrative claims database to investigate whether patients with diagnosed IDA undergoing primary TSA have higher rates of 1) in-hospital length of stay (LOS); 2) medical complications; and 3) implant-related complications.

Methods: A retrospective review from 2005 to 2014 was conducted using the Medicare Standard Analytical Files. Patients with IDA undergoing primary TSA were identified and matched to controls without IDA, in a 1:5 ratio by age, sex, and medical comorbidities. Outcomes analyzed included in-hospital LOS and 90-day medical and implant-related complications. Mann-Whitney U tests compared in-hospital LOS, and multivariate logistic regression was used to calculate odds ratios (ORs) on the effects of IDA on postoperative complications after adjusting for age, sex, and Elixhauser Comorbidity Index.

Results: A total of 17,689 patients with IDA and 88,445 without IDA participated in the matched-cohort analysis, with no differences in age, gender, and comorbidities (P = .99). IDA patients were found to have significantly longer in-hospital LOS (3-days vs. 2-days, P < .0001). IDA patients were also found to have significantly higher odds of 90-day implant-related complications (OR: 1.65, P < .0001), such as periprosthetic joint infections (OR: 1.80, P < .0001) and 90-day medical complications (OR: 2.87, P < .0001), including blood transfusions (OR: 10.37, P < .0001).

Conclusion: Patients with IDA undergoing primary TSA have significantly longer in-hospital LOS, and medical and implant-related complications. Patients were 10 times more likely to undergo a blood transfusion and 2 times more likely to have a periprosthetic fracture.

Keywords: Total shoulder arthroplasty; complications; iron deficiency anemia; length of stay; outcomes.

MeSH terms

Aged
Anemia, Iron-Deficiency* / complications
Anemia, Iron-Deficiency* / epidemiology
Arthroplasty, Replacement, Shoulder* / adverse effects
Humans
Length of Stay
Medicare
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Retrospective Studies
Risk Factors
United States / epidemiology