Outcomes following total shoulder arthroplasty in patients with systemic lupus erythematosus

Total shoulder arthroplasty (TSA) is a common procedure that may be considered for patients with glenohumeral osteoarthritis. Patients undergoing this procedure may be afflicted by comorbid conditions, such as systemic lupus erythematosus (SLE), which may impact odds of various postoperative complications. Adult patients with and without SLE who underwent TSA (anatomic or reverse) were queried from the January 2010 to October 2022 PearlDiver M165 database. Patients with and without SLE were matched (1:4) based on age, sex, and Elixhauser Comorbidity Index. Ninety-day adverse events and 5-year implant survival were assessed and compared with multivariable analysis. Subanalyses were done for SLE patients with and without a prescription of immunomodulatory therapy (IMT; corticosteroids, hydroxychloroquine, and/or biologics) within 90 days before surgery and compared to non-SLE patients with multivariable analyses. Lastly, SLE patients with and without a 90-day history of IMT were directly compared with multivariate logistic regression. A Bonferroni correction was applied to univariable analyses and multivariable regressions. Of 211,832 TSA patients identified, SLE was noted for 2228 (1.1%). After matching, 8261 patients without SLE and 2085 patients with SLE were selected. SLE patients were at an increased odds of 90-day aggregated events including severe (odds ratio [OR] = 3.50), minor (OR = 3.13), all (OR = 2.35), and orthopedic-related (OR = 1.41) adverse events (P