Increased preoperative aspartate aminotransferase-to-platelet ratio index predicts complications following total shoulder arthroplasty

Steven H Liu; Patricia Cerri-Droz; Kenny Ling; Rachel A Loyst; Stephen Bowen; Brandon Lung; David E Komatsu; Edward D Wang

doi:10.1016/j.jseint.2023.06.006

Increased preoperative aspartate aminotransferase-to-platelet ratio index predicts complications following total shoulder arthroplasty

JSES Int. 2023 Jul 3;7(5):855-860. doi: 10.1016/j.jseint.2023.06.006. eCollection 2023 Sep.

Authors

Steven H Liu¹, Patricia Cerri-Droz¹, Kenny Ling¹, Rachel A Loyst¹, Stephen Bowen², Brandon Lung³, David E Komatsu², Edward D Wang²

Affiliations

¹ Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
² Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA.
³ Department of Orthopaedic Surgery, University of California Irvine, Orange, CA, USA.

Abstract

Background: This study investigates the association between aspartate aminotransferase-to-platelet ratio index (APRI), a noninvasive measure of liver function, and 30-day postoperative complications following total shoulder arthroplasty (TSA).

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent TSA between 2015 and 2021. The study population was divided into 4 groups based on preoperative APRI: normal/reference (APRI ≤ 0.5), mild fibrosis (0.5 < APRI ≤ 0.7), significant fibrosis (0.7 < APRI ≤ 1), and cirrhosis (APRI > 1). Multivariate logistic regression analysis was conducted to investigate the connection between preoperative APRI and postoperative complications.

Results: Compared to the reference group, significant fibrosis was independently associated with a greater likelihood of major complications (odds ratio [OR]: 1.82, 95% confidence interval [CI]: 1.11-2.99; P = .017), minor complications (OR: 2.70, 95% CI: 1.67-4.37; P < .001), pneumonia (OR: 5.78, 95% CI: 2.58-12.95; P < .001), blood transfusions (OR: 2.89, 95% CI: 1.57-5.32; P < .001), readmission (OR: 1.88, 95% CI: 1.10-3.21; P = .022), and non-home discharge (OR: 1.83, 95% CI: 1.23-2.73; P = .003). Cirrhosis was independently associated with a greater likelihood of minor complications (OR: 3.96, 95% CI: 2.67-5.88; P < .001), blood transfusions (OR: 5.85, 95% CI: 3.79-9.03; P < .001), failure to wean off a ventilator (OR: 9.10, 95% CI: 1.98-41.82; P = .005), and non-home discharge (OR: 2.06, 95% CI: 1.43-2.96; P < .001).

Conclusion: Increasing preoperative APRI was associated with an increasing rate of postoperative complications following TSA.

Keywords: Aspartate aminotransferase-to-platelet ratio index; Cirrhosis; Complications; Liver damage; Liver fibrosis; Postoperative; Total shoulder arthroplasty.