Conclusion There are many risk factors associated with developing an infection after elective shoulder surgery .
The findings of this systematic review are clinical ly relevant as it has been shown that infection after shoulder surgery results in poor patient-reported outcomes and pose a significant financial burden .
Purpose Infection is a concern after all orthopedic procedures , including shoulder surgery .
This systematic review of literature aim ed to determine risk factors for infection as well as the availability and effectiveness of measures utilized to prevent infection after elective shoulder surgery .
Obesity is Not Associated with Increased Short-term Complications After Primary Total Shoulder Arthroplasty
Background Few studies have analyzed the association between elevated BMI and complications after total shoulder arthroplasty ( TSA ) . Previous studies have not consistently arrived at the same conclusion regarding whether obesity is associated with a greater number of postoperative complications . We used a national surgical data base to compare the 30-day complication profile and hospitalization outcomes after primary TSA among patients in different BMI categories . Questions / purpose sWe asked : ( 1 ) Is obesity associated with an increased risk of complications within 30 days of primary TSA ? ( 2 ) Is obesity associated with increased operative time ? Methods The American College of Surgeons National Surgical Quality Improvement Program ® data base for 2006 to 2012 was queried to identify all patients who underwent a primary TSA for osteoarthritis of the shoulder . The ACS-NSQIP ® data base was selected for this study as it is a nationally representative data base that provides prospect ively collected perioperative data and a comprehensive patient medical profile . Exclusion criteria included revision TSA , infection , tumor , or fracture . We analyzed 4796 patients who underwent a primary TSA for osteoarthritis of the shoulder . Patients who underwent a TSA  were divided in four BMI categories : normal ( 18.5–25 kg/m2 ) , overweight ( 25–30 kg/m2 ) , obesity Class 1 ( 30–35 kg/m2 ) , and obesity Class 2 or greater ( > 35 kg/m2 ) . Perioperative hospitalization data and 30-day postoperative complications were compared among different BMI classes . Differences in patient demographics , preoperative laboratory values , and preexisting patient comorbidities also were analyzed among different BMI groups , and multivariate analysis was used to adjust for any potential confounding variables . Results There was no association between BMI and 30-day complications after surgery ( normal as reference , overweight group relative risk : 0.57 [ 95 % CI , 0.30–1.06 ] , p = 0.076 ; obesity Class 1 relative risk : 0.52 [ 95 % CI , 0.26–1.03 ] , p = 0.061 ; obesity Class 2 or greater relative risk : 0.54 [ 95 % CI , 0.25–1.17 ] , p = 0.117 ) . However , greater BMI was associated with longer surgical times ( for normal BMI control group : 110 minutes , SD , 42 minutes ; overweight group : 115 minutes , SD , 46 minutes , mean difference to control : 5 minutes [ 95 % CI , −1 to 10 minutes ] , p = 0.096 ; obesity Class 1 : 120 minutes , SD , 43 minutes , mean difference : 10 minutes [ 95 % CI , 5–15 minutes ] , p < 0.001 ; obesity Class 2 or greater : 122 minutes , SD , 45 minutes , mean difference : 12 minutes [ 95 % CI , 6–18 minutes ] , p < 0.001 ) . Conclusions Although the surgical time increased for patients with greater BMI , the 30-day complications and perioperative hospitalization data after TSA were not different in patients with increased BMI levels . Obesity alone should not be a contraindication for TSA , and obese patients can expect similar incidences of postoperative complications . The preoperative medical optimization plan should be consistent with that of patients who are not obese who undergo TSA.Level of Evidence Level III , therapeutic study
Conclusion There are many risk factors associated with developing an infection after elective shoulder surgery .
The findings of this systematic review are clinical ly relevant as it has been shown that infection after shoulder surgery results in poor patient-reported outcomes and pose a significant financial burden .
Purpose Infection is a concern after all orthopedic procedures , including shoulder surgery .
This systematic review of literature aim ed to determine risk factors for infection as well as the availability and effectiveness of measures utilized to prevent infection after elective shoulder surgery .