Liver dysfunction is associated with early postoperative complications following revision total shoulder arthroplasty

Background: This study investigates the association between the Aspartate Aminotransferase-to-Platelet Ratio Index (APRI), a simple and accessible measure of liver dysfunction, and 30-day postoperative complications following revision total shoulder arthroplasty (TSA). Methods: The ACS-NSQIP database was queried for all patients who underwent revision TSA between 2015 and 2022, identifying 2619 cases, of which 954 met inclusion criteria. Early postoperative complications, occurring within 30 days of surgery, were recorded. The study population was divided into three groups based on preoperative APRI: normal/reference (APRI ≤ 0.5), fibrosis (0.5 ≤ APRI < 1), and cirrhosis (APRI ≥ 1). Logistic regression analysis was conducted to investigate the association between preoperative APRI and postoperative complications. Results: Compared to normal liver function, fibrosis was independently associated with a greater likelihood of non-home discharge (odds ratio [OR] 2.28, 95% confidence interval [CI] 1.04-5.00; P = .039). Compared to normal liver function, cirrhosis was independently associated with a greater likelihood of experiencing pneumonia (OR 51.70, 95% CI 2.82-948.46; P = 0.008), blood transfusions (OR 4.52, 95% CI 1.26-16.19; P = 0.020), and deep vein thrombosis (OR 23.91, 95% CI 1.93-296.27; P = 0.013). Discussion: Fibrosis and cirrhosis based on APRI are predictors of early complications following revision TSA. Level of Evidence: Level III; Retrospective Cohort Comparison; Prognosis Study.