Preoperative COVID-19 infection increases risk for 60-day complications following total shoulder arthroplasty: a propensity-matched analysis

Background: Total shoulder arthroplasty (TSA) is an effective treatment for a wide range of shoulder pathologies. Literature investigating the impact of COVID-19 diagnosis on outcomes following TSA is limited. The objective of this study was to perform a retrospective multi-institutional database analysis to investigate the association between preoperative COVID-19 diagnosis and 60-day complications following TSA. Methods: We queried the TriNetX database using Current Procedural Terminology and the International Classification of Diseases, Tenth Revision codes for patients who underwent a TSA from January 1, 2018 to July 1, 2023. Patients were categorized by those who had and those who did not have a diagnosis of COVID-19 within 30 days prior to surgery. The cohorts were matched based on age, gender, ethnicity, race, and past medical history. Chi-square analysis was performed to determine the relationship between COVID-19 diagnosis and 60-day postoperative complications including pneumonia, sepsis, emergency department (ED) visit, hospital admission, mortality, periprosthetic fracture, superficial wound infection, deep vein thrombosis (DVT), pulmonary embolism (PE), acute myocardial infarction, and revision surgery. The search results identified a total 63,768 patients who met study criteria. Of these patients, 7118 (11.08%) were diagnosed with COVID-19 within 30 days prior to their TSA procedure. Propensity score matching resulted in 6982 patients in each of the 2 cohorts. Results: Patients with a recent COVID-19 diagnosis prior to surgery had 1.96 (P = .0005) times the odds of sepsis, 1.42 (P = .0032) times the odds of superficial wound infections, 1.42 (P < .0001) times the odds of DVT, 1.52 (P = .0001) times the odds of PE, 1.10 (P = .0249) and 1.79 (P < .0001) times the odds of ED visits and hospital admissions, respectively, and 3.10 (P < .0001) and 2.87 (P < .0001) times the odds of periprosthetic fracture and revision surgery within 60 days of TSA. Conclusions: Our study suggests an increased risk of sepsis, ED visits, hospital admissions, periprosthetic fracture, superficial wound infection, DVT, PE, and revision surgery in TSA patients with a recent COVID-19 diagnosis. There may be significant benefit to closer monitoring and greater preventive measures to reduce the occurrence of postoperative complications in this setting. In addition, patients may benefit from postponing elective TSA procedures in the setting of a recent COVID-19 infection.