Outcomes and Complications of Shoulder Arthroplasty in Patients With Inflammatory Bowel Disease: A Large Insurance Claims Matched Cohort Analysis

Abstract

Introduction: Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn disease, is a chronic condition that affects the gastrointestinal tract and is associated with an increased risk of osteoporosis and fractures. With shoulder arthroplasty becoming more common, especially among aging populations, this study investigates the outcomes and complications of shoulder arthroplasty in patients with IBD. Methods: A retrospective cohort study using the PearlDiver database analyzed national insurance claims data from patients aged older than 18 years who underwent primary shoulder arthroplasty between 2010 and 2020. Patients with IBD were matched with control subjects by age, sex, and comorbidities. Primary outcomes included rates of revision arthroplasty and rotator cuff repair (RCR) between 2010 and 2020, while secondary outcomes included 90-day postoperative complications, such as infections, emergency department visits, and medical complications including deep vein thrombosis, pneumonia, and IBD-associated sepsis. Statistical significance was assessed using chi-square and multivariate analysis. Results: Of the 8114 patients, 93.9% were older than 50 and 62.7% were female. Patients with IBD had markedly higher rates of 90-day complications, including infections (OR 4.93), ED visits (OR 4.89), pneumonia (OR 6.42), and IBD-associated sepsis (OR 16.9), among others. In addition, patients with IBD were more likely to require rotator cuff repair (OR 1.38) and undergo revision procedures (OR 1.33) compared with control subjects (P-values all < 0.01). Conclusion: Patients with IBD undergoing shoulder arthroplasty face a higher risk of postoperative complications and revision surgeries. These findings highlight the importance of careful preoperative evaluation and tailored postoperative care for this patient group. Level of Evidence: IV.