The association of alcohol use disorder with perioperative outcomes after primary total shoulder arthroplasty for glenohumeral osteoarthritis: a retrospective matched cohort study

According to the World Health Organization, alcohol use disorder (AUD) is one of the leading mental health disorders in the United States. As the utilization of primary total shoulder arthroplasties (TSAs) continues to increase nationwide for the treatment of glenohumeral osteoarthritis (OA), studies evaluating the association of AUD with outcomes after primary TSA are warranted. Therefore, the aim of this study was to determine whether patients who undergo TSA and who have AUD have higher in-hospital lengths of stay (LOS), medical complications, and health care expenditures. The Parts A and B 100% Medicare Claims Database were queried to identify patients who underwent primary TSA for glenohumeral OA and have AUD from January 1, 2005 to March 31, 2014. Patients were 1:5 ratio matched to a comparison cohort by age, sex, and various comorbid conditions. The query yielded 32,846 patients in the study (n = 5479) and comparison (n = 27,367) cohorts. The variables of interest include comparison of in-hospital LOS, 90-day medical complications, and day of surgery and 90-day health care costs. Welch’s t- tests were used to compare LOS, whereas multivariate logistic regression analyses were used to calculate the odds ratio (OR) of AUD on complications. A P value less than 0.001 was considered to be statistically significant. Patients with AUD had significantly longer in-hospital LOS (4 vs. 2 days, P < .0001), in addition to higher rates and odds of 90-day complications (30.44% vs. 7.94%; OR: 1.85, P < .0001) such as surgical site infections (1.15 vs. 0.24%; OR: 2.33, P < .0001), cerebrovascular accidents (5.06 vs. 1.23%; OR: 2.16, P < .0001), respiratory failures (5.79 vs. 1.52%; OR: 2.02, P < .0001), myocardial infarctions (1.53 vs. 0.43%; OR: 2.01, P < .0001), acute kidney injuries (6.55 vs. 1.34%; OR: 1.89, P < .0001), and other complications. In addition, patients in the study group incurred significantly higher day of surgery ($12,160.60 vs. $11,308.48, P < .0001) and 90-day episode of care costs ($14,493.13 vs. $13,087.55, P < .0001). As the prevalence of AUD continues to increase nationwide, understanding the association of AUD with outcomes after primary TSA for the treatment of glenohumeral OA is necessary. The current investigation is important as health care professionals and orthopedists can use this information to adequately educate patients on potential complications which may occur after their procedure.