Effect of Comorbidities on Short-Term Postoperative Complications Following total Shoulder Arthroplasty: A TriNetX Study

Purpose: Although nonmodifiable medical comorbidities are known to increase postoperative risk following total shoulder arthroplasty (TSA), the impact of potentially modifiable behavioral risk factors is less established. This study evaluated the effects of ischemic heart disease (IHD), type II diabetes mellitus (T2DM), cannabis use disorder (CUD), and nicotine dependence (ND), on short-term postoperative complications following TSA. Methods: This retrospective cohort study used the TriNetX US Collaborative Network to identify patients undergoing primary TSA from 2004 to 2024 using CPT codes. Patients were stratified into cohorts according to ICD-10-CM diagnoses of IHD, T2DM, CUD, and ND. Propensity score matching (1:1) was done to balance baseline demographics and BMI. The primary outcome was 90-day complications. Results: Among 59,473 patients included, each comorbidity cohort showed notable increases in complications. Patients with IHD had greater odds of postoperative cardiac arrest (OR 6.825, CI, 3.513 to 13.26), acute kidney failure (OR 3.642, CI, 3.108 to 4.268), and pneumonia (OR 2.892, CI, 2.411 to 3.467). Patients with CUD had the highest odds of acute kidney failure (OR 2.539, CI, 1.556 to 4.143). T2DM was associated with increased skin infections (OR 2.151, CI, 1.806 to 2.562) and cardiac arrest (OR 3.159, CI, 1.692 to 5.898), whereas ND was associated with higher rates of pneumonia (OR 2.081, CI, 1.651 to 2.624) and acute kidney failure (OR 1.893, CI, 1.535 to 2.334). Conclusion: Both nonmodifiable comorbidities and modifiable risk factors markedly increase the risk of specific 90-day postoperative complications following TSA. These findings support targeted preoperative risk stratification and suggest optimizing CUD and ND may improve perioperative outcomes, although prospective studies are needed.