Early postoperative adverse cardiac events following total shoulder arthroplasty: a propensity-matched analysis of risk factors

Background: Cardiac complications following total shoulder arthroplasty (TSA) are rare, potentially life-threatening events. Identifying risk factors (RF) for cardiac complications remains of interest to treating surgeons. This study aims to assess the impact of common comorbidities on perioperative cardiac complication risk following TSA. Methods: Using the TriNetX national multicenter database, we identified patients who underwent TSA from January 2015 to January 2024. Patients were grouped into cohorts based on the presence or absence of cardiac RFs, such as diabetes mellitus (DM), renal insufficiency, previous myocardial infarction (MI), hypertension, and cerebrovascular disease (CVD) to create at-risk vs. control cohorts. These groups underwent 1:1 propensity score matching by age, sex, race, and ethnicity. A subanalysis for each specific RF was conducted. The incidence of postoperative adverse cardiac events was assessed at 1- and 3-month intervals using chi-squared tests, with a significance threshold set at P < .002 following multiple comparison correction. Results: After 1:1 propensity matching, 13,128 TSA patients were available for final analysis. At-risk patients with comorbidities had 1.4-3.8 times greater odds of postoperative heart failure at 30 days and 90 days (P < .001) compared to controls. Patients with a history of CVD had 2.0 times greater odds of 30-day MI and heart failure compared to controls (P < .001). Patients with a history of MI had the highest odds of troponin elevation (OR 3.8, P < .001), MI (OR 21.0, P < .001), and heart failure (OR 3.3, P < .001) within the early postoperative period. Conclusion: Patients with a history of MI, renal insufficiency, hypertension, CVD, or diabetes mellitus were associated with significantly greater odds of adverse cardiac events at 30 and 90 days following TSA. History of prior MI was the strongest independent RF, with an associated 21 times greater odds of postoperative MI at 30 and 90 days.