Outcomes and complications of shoulder arthroplasty in patients with arterial disease: A large insurance claims matched cohort analysis

Arterial disease (AD), encompassing peripheral arterial disease (PAD) and coronary artery disease (CAD), is linked to reduced vascular perfusion and increased risks of complications in orthopaedic procedures. The impact of AD on outcomes following shoulder arthroplasty remains understudied. This study aimed to evaluate the effects of AD on postoperative complications, revision rates, and healthcare costs in shoulder arthroplasty patients. Using the PearlDiver database, this retrospective study analyzed patients undergoing shoulder arthroplasty from 2010 to 2020. Patients with and without AD were matched 1:1 by age and gender. Outcomes included 90-day postoperative complications, revision arthroplasty, and rotator cuff repair. Chi-square and multivariate analyses were conducted to evaluate the association between AD and adverse outcomes. Of 191,178 patients, 33.7 % had a preoperative diagnosis of AD. Patients with AD experienced significantly higher rates of 90-day complications, including infection (OR 6.86), acute kidney injury (OR 9.61), cardiac arrhythmia (OR 19.34), and pneumonia (OR 8.80) (all p < 0.001). AD was also associated with increased revision arthroplasty (OR 1.10) and rotator cuff repair (OR 1.18). Median costs were significantly higher in the AD group compared to controls ($3975 vs. $3,490, p < 0.001). Multivariate analysis confirmed AD as an independent predictor of adverse outcomes. AD significantly increases the risk of postoperative complications, revision procedures, and healthcare costs in patients undergoing shoulder arthroplasty. These findings emphasize the need for risk stratification and targeted management in this high-risk population. Future prospective studies are warranted to establish clinically significant thresholds and refine perioperative care strategies.