ABSTRACT
PURPOSE: The purpose of this study is to identify risk factors for delays in planned total shoulder arthroplasty (TSA) and determine the perioperative outcomes of TSAs that experienced a delay. METHODS: The American College of Surgeons National Quality Improvement Program (NSQIP) database was queried from 2006 to 2019 for primary TSA. Delayed TSA was defined as surgery that occurred greater than one day after hospital admission. Patient demographics, comorbidities, and post-operative complications were collected and compared; the incidence of delayed TSA was analyzed. RESULTS: The delayed patients were older, had a higher BMI, a higher rate of recent prior major surgery, and more comorbidities. Delayed patients had higher rates of postoperative complications, return to the OR, and 30-day readmission. Between 2006 and 2019, the rate of delayed TSA decreased. CONCLUSION: Surgeons should take care to ensure that patients with comorbidities undergo thorough preoperative clearance to prevent same-day cancellations and postoperative complications.
Subject(s)
Arthroplasty, Replacement, Shoulder , Elective Surgical Procedures , Postoperative Complications , Humans , Arthroplasty, Replacement, Shoulder/methods , Arthroplasty, Replacement, Shoulder/adverse effects , Male , Female , Aged , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Elective Surgical Procedures/adverse effects , Elective Surgical Procedures/methods , Risk Factors , Time-to-Treatment/statistics & numerical data , Treatment Outcome , Retrospective Studies , Aged, 80 and over , ComorbidityABSTRACT
Background: Dermabond Prineo is popular for wound closure due to its anti-microbial attribute, ease of application, and patient comfort. Reports of allergic contact dermatitis have increased, likely due to increased usage, mostly in breast augmentations and joint replacements. To the authors' knowledge, this is the first report of allergic contact dermatitis following spine surgery. Case Description: This case involved a 47-year-old male with a history of two posterior L5-S1 lumbar microdiscectomies. Dermabond Prineo was used in the revision microdiscectomy with no skin complications noted. Six weeks after revision microdiscectomy, the patient underwent discectomy and anterior lumbar interbody fusion of L5-S1, again closed with Dermabond Prineo. One week later, the patient presented with allergic contact dermatitis around his incision, which was treated with topical hydrocortisone and diphenhydramine. Around the same time, he was diagnosed with post-operative pneumonia. Conclusions: Previous studies have suggested that repeated usage and duplicate coverage with 2-octyl cyanoacrylate (Dermabond Prineo) correlate with an increased risk of allergic reaction. Type IV hypersensitivity reactions require an initial sensitization to the allergen and subsequent re-exposure for reaction. In this case, the revision microdiscectomy closed with Dermabond Prineo functioned as the sensitization and repeated usage in a subsequent discectomy caused an allergic reaction. Providers should be aware of the increased risk of allergic reaction when using Dermabond Prineo for repeat surgeries.
