The Impact of Preoperative Anemia on Complications After Total Shoulder Arthroplasty

Background: This study investigated the relationship between varying levels of preoperative anemia and postoperative complications within 30 days of total shoulder arthroplasty (TSA). Methods: All patients who underwent TSA from 2015 to 2017 were queried from the American College of Surgeons National Surgical Quality Improvement database. Patients were categorized based on preoperative hematocrit levels: normal (>39% for men and >36% for women), mild anemia (29% to 39% for men and 29% to 36% for women), and severe anemia (<29% for both men and women). Results: A total of 10,547 patients were included in the study. Of these patients, 1,923 patients were (18.2%) in the mild anemia cohort and 146 (1.4%) were in the severe anemia cohort. Mild anemia was identified as a significant predictor of any complication (odds ratio [OR] 2.74, P < 0.001), stroke/cerebrovascular accident (OR 6.79, P = 0.007), postoperative anemia requiring transfusion (OR 6.58, P < 0.001), nonhome discharge (OR 1.79, P < 0.001), readmission (OR 1.63, P < 0.001), and return to the surgical room (OR 1.60, P = 0.017). Severe anemia was identified as a significant predictor of any complication (OR 4.31, P < 0.001), renal complication (OR 13.78, P < 0.001), postoperative anemia requiring transfusion (OR 5.62, P < 0.001), and nonhome discharge (OR 2.34, P < 0.001). Conclusion: Preoperative anemia status is a risk factor for complications within 30 days of TSA.