Increased Risk of 90-Day Complications in Patients With Fibromyalgia Undergoing Total Shoulder Arthroplasty.

Joshua G Sanchez, Albert L Rancu, Fortunay H Diatta, Anshu Jonnalagadda, Meera M Dhodapkar, Leonard Knoedler, Martin Kauke-Navarro, Jonathan N Grauer
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Abstract

Introduction: Anatomic and reverse total shoulder arthroplasties (TSAs) are effective treatment options for end-stage glenohumeral osteoarthritis. Those undergoing TSA may also have fibromyalgia, a musculoskeletal condition. However, the association of fibromyalgia with shorter and longer term outcomes after TSA has not been well characterized.

Methods: Patients undergoing TSA for osteoarthritis indications were identified in the PearlDiver M165 database from January 2016 to October 2022. Exclusion criteria included age younger than 18 years, shoulder infection, neoplasm, or trauma within 90 days before surgery, and inactivity in the database within 90 days of surgery. Patients with fibromyalgia were matched in a 1:4 ratio to patients without based on age, sex, and Elixhauser Comorbidity Index. Ninety-day adverse events were compared using univariable and multivariable analyses. Five-year revision-free survival was compared using the log-rank test.

Results: Of 163,565 TSA patients, fibromyalgia was identified for 9,035 (5.52%). After matching, cohorts of 30,770 non-fibromyalgia patients and 7,738 patients with fibromyalgia were identified. Multivariable analyses demonstrated patients with fibromyalgia were at independently increased odds ratios (ORs) for the following 90-day complications (decreasing OR order): urinary tract infection (OR = 4.49), wound dehiscence (OR = 3.63), pneumonia (OR = 3.46), emergency department visit (OR = 3.45), sepsis (OR = 3.15), surgical site infection (OR = 2.82), cardiac events (OR = 2.72), acute kidney injury (OR = 2.65), deep vein thrombosis (OR = 2.48), hematoma (OR = 2.03), and pulmonary embolism (OR = 2.01) (P < 0.05 for each). These individual complications contributed to the increased odds of aggregated minor adverse events (OR = 3.68), all adverse events (OR = 3.48), and severe adverse events (OR = 2.68) (P < 0.05 for each). No statistically significant difference was observed in 5-year revision-free survival between groups.

Discussion: This study found TSA patients with fibromyalgia to be at increased risk of adverse events within 90 days of surgery. Proper surgical planning and patient counseling are crucial to this population. Nonetheless, it was reassuring that those with fibromyalgia had similar 5-year revision-free survival compared with those without.

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接受全肩关节置换术的纤维肌痛患者 90 天并发症风险增加。
导言:解剖和反向全肩关节置换术(TSA)是治疗终末期盂肱骨关节炎的有效方法。接受全肩关节置换术的患者也可能患有纤维肌痛这种肌肉骨骼疾病。然而,纤维肌痛与TSA术后短期和长期疗效的关系尚未得到很好的描述:2016年1月至2022年10月期间,在PearlDiver M165数据库中确定了因骨关节炎适应症接受TSA的患者。排除标准包括年龄小于18岁,术前90天内有肩部感染、肿瘤或外伤,以及术后90天内未在数据库中活动。根据年龄、性别和Elixhauser合并症指数,纤维肌痛患者与非纤维肌痛患者按1:4的比例进行配对。通过单变量和多变量分析比较了90天不良事件。使用对数秩检验比较了五年无翻修生存率:在163565名TSA患者中,有9035人(5.52%)患有纤维肌痛。经过配对,确定了 30,770 名非纤维肌痛患者和 7,738 名纤维肌痛患者。多变量分析表明,纤维肌痛患者出现以下 90 天并发症的几率比(ORs)独立增加(ORs 顺序递减):尿路感染(OR = 4.49)、伤口裂开(OR = 3.63)、肺炎(OR = 3.46)、急诊就诊(OR = 3.45)、败血症(OR = 3.15)、手术部位感染(OR = 2.82)、心脏事件(OR = 2.72)、急性肾损伤(OR = 2.65)、深静脉血栓形成(OR = 2.48)、血肿(OR = 2.03)和肺栓塞(OR = 2.01)(P < 0.05)。这些并发症导致轻微不良事件(OR = 3.68)、所有不良事件(OR = 3.48)和严重不良事件(OR = 2.68)的发生几率增加(P < 0.05)。各组间的5年无翻修生存率差异无统计学意义:本研究发现,患有纤维肌痛的TSA患者在术后90天内发生不良事件的风险增加。正确的手术计划和患者咨询对这类人群至关重要。尽管如此,令人欣慰的是,与无纤维肌痛的患者相比,有纤维肌痛的患者有相似的 5 年无翻修生存率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.60
自引率
6.70%
发文量
282
审稿时长
8 weeks
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