Postoperative gastrointestinal hemorrhage after total shoulder arthroplasty: a propensity-matched analysis of risk factors, complication profiles, and economic implications.

Abstract

Utilization of total shoulder arthroplasty (TSA) has increased significantly and is highly successful. One uncommon complication, postoperative gastrointestinal (GI) bleeding, has recently been noted following total joint arthroplasty procedures. This study aims to determine the incidence of GI bleeding following TSA, identify risk factors for GI bleeding, and assess postoperative outcomes at 90 days and 1 year, with corresponding cost analyses at 90 days postoperative. This retrospective database study identified patients who underwent primary anatomic and reverse TSA between 2010 and 2020. GI bleeding events were defined using ICD-9 and ICD-10 diagnosis codes. Patients were stratified into two cohorts based on the presence or absence of a GI bleed and were 1:1 propensity score matched. Risk factors found to be significant on univariable analysis were included in a multivariable logistic regression model to assess their independent association with postoperative GI bleeding. Multivariable logistic regression was performed to evaluate the association between postoperative GI bleeding and complications at 90 days and 1 year. Cost analysis was conducted by comparing total outpatient and inpatient charges within 90 days postoperatively. A total of 171,059 patients who underwent TSA were included in the prematched baseline cohort. Of these, 1447 patients (0.8 %) experienced a postoperative GI bleed. After 1:1 matching of cohorts, multivariable logistic regression analysis found prior GI bleeding to significantly increase the odds of postoperative GI bleeding. Patients with GI bleeding also had significantly worse postoperative outcomes at both timepoints. Ninety-day outpatient costs following TSA were significantly higher in patients who experienced a postoperative GI bleed. The findings of this study suggest that GI bleeding represents a marker of systemic vulnerability and is associated with increased morbidity and cost. Enhanced perioperative vigilance, targeted prophylaxis, and integrated care pathways may help mitigate the impact of this complication and improve outcomes in TSA patients.