title: Analysis of perioperative morbidity and mortality in shoulder arthroplasty patients with preexisting alcohol use disorders.
abstract: BACKGROUND
  Shoulder arthroplasty is becoming increasingly popular in the United States. Given the high prevalence of alcohol abuse and its implications in postoperative morbidity and the increasing incidence of shoulder arthroplasty, it is prudent to explore the effect of alcohol use disorders (AUDs) in this patient population. In this study, we considered numerous outcome variables, including perioperative complications, in-hospital death, prolonged hospital stay, and nonroutine discharge.
  
  
  METHODS
  Using the Nationwide Inpatient Sample, we performed a retrospective cohort study to identify a population of 422,371 adults (≥18 years old) undergoing total shoulder arthroplasty or hemiarthroplasty between January 1, 2002, and December 31, 2011. We then further subdivided this cohort into those who were classified as having AUDs and those who did not. Comparisons of early postoperative outcome measures were performed by bivariate and multivariable analyses with logistic regression modeling.
  
  
  RESULTS
  Compared with those without AUDs, patients undergoing shoulder arthroplasty with a preexisting AUD have a greater likelihood to experience 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 a preexisting AUD are 2.7 times more likely to experience perioperative complications after shoulder arthroplasty.
  
  
  CONCLUSIONS
  Patients undergoing shoulder arthroplasty with a preexisting AUD have a greater likelihood of perioperative complications and health care resource utilization after shoulder arthroplasty. Presurgical alcohol screening may prove effective in identifying at-risk patients, and providing interventions before surgery may effectively limit the complication profile.
authors.affiliation: Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: bponce@uabmc.edu.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Ponce
authors.affiliation: Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Lasun O
authors.initials: LO
authors.lastname: Oladeji
authors.affiliation: Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Raley
authors.affiliation: Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Mariano E
authors.initials: ME
authors.lastname: Menendez
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019973:Alcohol-Related Disorders / Q000150:complications / Q000453:epidemiology*; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000401:mortality*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D062785:Hemiarthroplasty / Q000009:adverse effects* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000601:surgery*; D014481:United States / Q000453:epidemiology; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology
keywords: Nationwide Inpatient Sample; alcohol use disorders; perioperative; shoulder arthroplasty