The Association of Benign Prostatic Hyperplasia on Postoperative Complications and Periprosthetic Joint Infections Following Total Shoulder Arthroplasty
Restricted accessResearch articleFirst published online April, 2023
The Association of Benign Prostatic Hyperplasia on Postoperative Complications and Periprosthetic Joint Infections Following Total Shoulder Arthroplasty
A recently proposed risk factor for periprosthetic joint infections (PJI) in men is benign prostatic hyperplasia (BPH). The objective was to explore the association of BPH on 1) 90-day complications, 2) length of stay (LOS), 3) readmission rates, and 4) healthcare expenditures following total shoulder arthroplasty (TSA).
Methods
A retrospective query was performed using a nationwide claims database from January 2005 to March 2014 for male patients undergoing primary TSA. The study cohort included 5067 patients with BPH while 50,720 patients served as the comparison cohort. Logistic regression determined the association of BPH on complications and readmissions. A p value less than 0.001 was significant.
Results
Patients with BPH had higher incidence and odds (36.8 vs. 6.2%; OR: 2.73, p < 0.0001) of all ninety-day medical complications including PJIs (0.49 vs. 0.32%; OR: 1.54, p< 0.001). BPH patients had longer in-hospital LOS (3- vs. 2-days, p< 0.0001). Study group patients had higher 90-day episode of care reimbursements ($13,653 vs. $12,688), p< 0.0001).
Conclusions
BPH is associated with increased complications and healthcare expenditures following total shoulder arthroplasty. The investigation can be used to educate BPH patients of the possible adverse events which may occur within ninety-days following primary TSA for the treatment of glenohumeral osteoarthritis.
PaxtonESGreenAKruegerVS. Periprosthetic infections of the shoulder: diagnosis and management. J Am Acad Orthop Surg2019; 27: E935–E944.
2.
PadegimasEMMaltenfortMRamseyML,et al.Periprosthetic shoulder infection in the United States: incidence and economic burden. J Shoulder Elbow Surg2015; 24: 741–746.
3.
ContrerasESFrantzTLBishopJY,et al.Periprosthetic infection after reverse shoulder arthroplasty: a review. Curr Rev Musculoskelet Med2020; 13: 757–768.
4.
CooperMETrivediNNSivasundaramL,et al.Diagnosis and management of periprosthetic joint infection after shoulder arthroplasty. JBJS Rev2019; 7: e3.
5.
GarriguesGEZmistowskiBCooperAM, et al.Proceedings from the 2018 international consensus meeting on orthopedic infections: the definition of periprosthetic shoulder infection. J Shoulder Elbow Surg2019; 28: S8–S12.
6.
KunutsorSKWhitehouseMRBlomAW,et al.Patient-related risk factors for periprosthetic joint infection after total joint arthroplasty: a systematic review and meta-analysis. PLoS One2016; 11: e0150866.
7.
ManningLMetcalfSClarkB, et al.Clinical characteristics, etiology, and initial management strategy of newly diagnosed periprosthetic joint infection: a multicenter, prospective observational cohort study of 783 patients. Open Forum Infect Dis2020; 7: ofaa068.
8.
PatelVVErnstSMCRangarajanR,et al.Validation of new shoulder periprosthetic joint infection criteria. J Shoulder Elbow Surg2021; 30: S71–S76.
9.
SimhaSShieldsEJWWiaterJM. Periprosthetic infections of the shoulder. JBJS Rev2018; 6: e6.
10.
OkorohaKRMuhSGabbardM, et al.Early outcomes of shoulder arthroplasty according to sex. JSES Open Access2019; 3: 43–47.
RichardsJInacioMCSBeckettM, et al.Patient and procedure-specific risk factors for deep infection after primary shoulder arthroplasty. Clin Orthop Relat Res2014; 472: 2809–2815.
13.
MovermanMABruhaMJPaganiNR,et al.Perioperative medical optimization of symptomatic benign prostatic hyperplasia is an economically justified infection prevention strategy in total joint arthroplasty. J Arthroplasty2021; 36: 2551–2557.
14.
GuAAgarwalAFassihiSC,et al.Does symptomatic benign prostatic hyperplasia increase the risk of periprosthetic joint infection after primary total joint arthroplasty?J Arthroplasty2021; 36: 897–904.
15.
YazdiHRestrepoCFoltzC, et al.Symptomatic benign prostatic hyperplasia: a risk factor for periprosthetic joint infection in male patients. J Bone Joint Surg Am2020; 102: 543–549.
16.
LeeSWHChanEMCLaiYK. The global burden of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a systematic review and meta-analysis. Sci Rep2017; 7: 7984.
17.
MoheeARGascoyne-BinziDWestR,et al.Bacteraemia during transurethral resection of the prostate: what are the risk factors and is it more common than we think?PLoS One2016; 11: e0157864.
18.
PremkumarAKolinDAFarleyKX, et al.Projected economic burden of periprosthetic joint infection of the hip and knee in the United States. J Arthroplasty2021; 36: 1484–1489.e3.
19.
CaspAJMontgomerySRCancienneJM,et al.Osteoporosis and implant-related complications after anatomic and reverse total shoulder arthroplasty. J Am Acad Orthop Surg2020; 28: 121–127.
20.
DeaseyMJBellJEChenM,et al.A comparison of perioperative pain control in total shoulder arthroplasty: preoperative tramadol is associated with decreased long-term opiate use when compared with traditional opioids. Semin Arthroplasty2021; 31: 105–111.
21.
OdeGEOdumSConnorPM,et al.Ambulatory versus inpatient shoulder arthroplasty: a population-based analysis of trends, outcomes, and charges. JSES Int2020; 4: 27.
22.
CaspAJSmithJMBrockmeierSF,et al.Surgeon charges and reimbursements are declining compared with hospital payments for shoulder arthroplasty. J Shoulder Elbow Surg2020; 29: 924–930.
23.
CancienneJMBrockmeierSFGulotta LV,et al.Ambulatory total shoulder arthroplasty: a comprehensive analysis of current trends, complications, readmissions, and costs. J Bone Joint Surg Am2017; 99: 629–637.
24.
DayJSLauEOngKL,et al.Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015. J Shoulder Elbow Surg2010; 19: 1115–1120.
25.
KimSHWiseBLZhangY,et al.Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am2011; 93: 2249–2254.
26.
SloanMPremkumarAShethNP. Projected volume of primary total joint arthroplasty in the u.s., 2014 to 2030. J Bone Joint Surg Am2018; 100: 1455–1460.
27.
WagnerERFarleyKXHigginsI,et al.The incidence of shoulder arthroplasty: rise and future projections compared with hip and knee arthroplasty. J Shoulder Elbow Surg2020; 29: 2601–2609.
28.
FarleyKXWilsonJMDalyCA,et al.The incidence of shoulder arthroplasty: rise and future projections compared to hip and knee arthroplasty. JSES Open Access2019; 3: 44.
29.
FarleyKXWilsonJMKumarA, et al.Prevalence of shoulder arthroplasty in the United States and the increasing burden of revision shoulder arthroplasty. JBJS Open Access2021; 6: e20.00156.
30.
Wright-ChisemJApostolakosJMDinesJS, et al.The impact of prior ipsilateral arthroscopy on infection rates after shoulder arthroplasty. J Shoulder Elbow Surg2021; 30: 1596–1602.
31.
SmithJMCancienneJMBrockmeierSF,et al.Vitamin D deficiency and total shoulder arthroplasty complications. Shoulder Elbow2021; 13: 99–105.
32.
WernerBCBurrusMTBeghoI,et al.Early revision within 1 year after shoulder arthroplasty: patient factors and etiology. J Shoulder Elbow Surg2015; 24: e323–e330.
33.
CancienneJMBrockmeierSFCarrJC,et al.Implant removal and spacer placement for infected shoulder arthroplasty: risk factors for repeat procedures, spacer retention, and mortality. HSS J2018; 14: 228–232.
34.
CancienneJMBrockmeierSFWernerBC. Association of perioperative glycemic control with deep postoperative infection after shoulder arthroplasty in patients with diabetes. J Am Acad Orthop Surg2018; 26: e238–e245.
35.
WernerBCCancienneJMBurrusMT,et al.The timing of elective shoulder surgery after shoulder injection affects postoperative infection risk in medicare patients. J Shoulder Elbow Surg2016; 25: 390–397.
36.
WernerBCBurrusMTBrowneJA,et al.Superobesity (body mass index >50 kg/m2) and complications after total shoulder arthroplasty: an incremental effect of increasing body mass index. J Shoulder Elbow Surg2015; 24: 1868–1875.
37.
AibinderWSchochBParsonsM, et al.Risk factors for complications and revision surgery after anatomic and reverse total shoulder arthroplasty. J Shoulder Elbow Surg2021; 30: e689–e701.
38.
Gubbels BuppMRPotluriTFinkAL,et al.The confluence of sex hormones and aging on immunity. Front Immunol2018; 9: 1269.
39.
KleinSLFlanaganKL. Sex differences in immune responses. Nat Rev Immunol2016; 16: 626–638.
40.
WickmanJRGoltzDELevinJM,et al.Early aseptic reoperation after shoulder arthroplasty increases risk of subsequent prosthetic joint infection. JSES Int2021; 5: 1067–1071.
