Abstract
Background
The objective of this study is to investigate the effect of allergies on complications following total shoulder arthroplasty (TSA).
Materials and Methods
All data were collected by using the PearlDiver national database to identify patients who had undergone TSA (anatomic or reverse) between 1 January 2010 and 31 October 2021. Patients were stratified into two groups: allergies and no allergies. Comparisons were made regarding complications and revision surgeries. Complications were compared at 30 and 90 days. Revisions were compared at 1, 5 and 10 years postoperatively.
Results
This study identified 28,182 patients with allergies and 126,296 patients without allergies. Patients with allergies were more likely to require revision surgery at all time points analyzed (p < 0.001). Patients with allergies were more likely to have sepsis within 30 (OR 1.53 [1.30–1.80], p < 0.001) and 90 days (1.71 [1.51–1.94], p < 0.001) postoperatively. Patients with allergies were more likely to experience a wound complication within 30 (1.89 [1.58–2.26], p < 0.001) and 90 days (1.81 [1.58–2.08], p < 0.001). The allergy group experienced higher rates of prosthetic joint infections (PJI) (2.14 [1.81–2.54], p < 0.001) and implant complications at 90 days (1.52 [1.42–1.62], p < 0.001).
Discussion
Patients with allergies were more likely to require revision surgery, experience wound complications, sepsis and PJI following TSA.
Keywords: total shoulder arthroplasty, allergies, revision surgery, outcomes, national database
Introduction
Shoulder arthroplasty remains an effective treatment for degenerative shoulder diseases. This procedure largely results in improvement in motion, pain and quality of life. They are reliably successful in both older and younger patients.1,2 There is room for outcome improvement through the study of various prognostic factors. Identifying these variables are important to both the surgeon and patient for result optimization and expectation management.
There is limited evidence regarding the role allergies play in shoulder arthroplasty.
Prior studies have shown that anatomical abnormalities, previous surgeries and decreased baseline physical or mental status worsen outcomes of shoulder, knee and hip arthroplasty.3,4 Studies limited to hip and knee arthroplasty state that allergies lead to worse postoperative outcomes. Allergies such as metal, drugs and latex have been studied in the setting of shoulder arthroplasty. Kennon et al. found that shoulder arthroplasty offers satisfactory outcomes to patients with a self-reported metal allergy. 5 Antibiotic allergies were found to increase postoperative complications, and it is asserted that the use of preoperative allergy testing may have clinical merit. 6 Another study found that multiple patient-reported drug allergies did not affect shoulder arthroplasty, though it is limited by sample size. 7 The impact of the number of different allergies a patient has on shoulder arthroplasty specifically, remains unclear in current orthopedic literature.
The objective of this study is to investigate the effect of the number of allergies on complications following shoulder arthroplasty. We hypothesize that an increase in allergies will not lead to an increase in adverse outcomes following surgery.
Methods
The data for this study were collected from the PearlDiver patient record database (PearlDiver Technologies, IN, USA) between 1 January 2010 and 31 October 2021. The database contains blinded demographics and claims information for more than 92 million patients from various payer types. It is structured based on the International Classification of Diseases (ICD)-9 and ICD-10 classifications for diagnostic codes and Current Procedural Terminology (CPT) codes for procedure claims. The data are compiled and adjudicated by PearlDiver using specific ICD, CPT, USC and NDC codes that are billed to insurance companies by physicians or providers.
For this study, patients with insurance claims for total shoulder arthroplasty (TSA) and osteoarthritis prior to the TSA claims were included. The total population was divided into two groups: those with claims for any type of allergy (including drug, food, antibiotics and miscellaneous) and those without any claims for allergies.
Patients were tracked for 30 days, 90 days, 1 year and 5 years to identify diagnostic, medical and revision complications. Diagnostic complications included wound complications, post-operative stiffness, prosthetic joint infection (PJI) and implant complications as defined as hardware loosening or breaking. Medical complications included bleeding, sepsis and surgical site infections.
The primary objective of this study was to evaluate the differences in complication rates between the allergy and non-allergy groups during each of the four tracking periods. The chi-square test was used to analyze the differences in complication rates between the two groups at a p-value of 0.05. All data were analyzed using R Statistical Software version 4.1.0 within the PearlDiver Software. The total base population having diagnostic claims for TSA and osteoarthritis were stratified into patients having claims for any type of allergy (including drug, food, antibiotics and miscellaneous) and patients who did not have any claims for any type of allergy.
Results
During the study period, there were an estimated 154,478 patients (28,182 with allergies and 126,296 without allergies) who had undergone TSA. The number of patients requiring revisions following their initial TSA were recorded in each group at 30 days, 90 days, 1 year, 3 years, 5 years and 10 years postoperatively. Patients with allergies were more likely to require revision surgery at all time points analyzed (p < 0.001). Comparison of revision rates and odds ratios can be found in Table 1.
Table 1.
Revisions of allergy and non-allergy patients after shoulder arthroplasty.
| Time after surgery | Allergy patients, n (%) (n = 28,182) | Non-allergy patients, n (%) (n = 126,296) | Odds ratio | 95% CI | p Value | ||
|---|---|---|---|---|---|---|---|
| 30 days | 253 | (0.9) | 703 | (0.6) | 1.62 | 1.40 to 1.87 | <0.001 |
| 90 days | 400 | (1.4) | 1167 | (0.9) | 1.54 | 1.38 to 1.73 | <0.001 |
| 1 year | 692 | (2.5) | 2239 | (1.8) | 1.39 | 1.28 to 1.52 | <0.001 |
| 3 years | 927 | (3.3) | 3138 | (2.5) | 1.33 | 1.24 to 1.44 | <0.001 |
| 5 years | 982 | (3.5) | 3514 | (2.8) | 1.26 | 1.17 to 1.36 | <0.001 |
| 10 years | 1010 | (3.6) | 3846 | (3.0) | 1.18 | 1.10 to 1.27 | <0.001 |
Bolded values indicate statistically significant. CI = confidence interval.
The number of patients experiencing medical complications following TSA was recorded for each group at 30 days and 90 days postoperatively. There was no significant difference in bleeding complications between the two groups at 30 days (0.48% allergy vs. 0.40% non-allergy, OR 1.19 [95% CI 0.99 to 1.44], p = 0.078) but at 90 days, patients with allergies were more likely to have experienced an episode of bleeding (0.6% allergy vs. 0.4% non-allergy, OR 1.26 [95% CI 1.05 to 1.50], p = 0.012). Patients with allergies were more likely to have sepsis within 30 days (0.7% vs. 0.4%, OR 1.53 [95% CI 1.30 to 1.80], p < 0.001) and 90 days (1.3% vs. 0.7%, OR 1.71 [95% CI 1.51 to 1.94], p < 0.001) postoperatively. Patients without allergies were more likely to have a surgical site infection within 30 days after surgery (0.8% vs. 0.7%, OR 0.83 [95% CI 0.71 to 0.97], p = 0.019) but that difference was not observed at 90 days (1.1% non-allergy vs. 0.8% allergy, OR 0.89 [95% CI 0.78 to 1.01], p = 0.087). Patients without allergies had more total medical complications compared to patients with allergies at both 30 days (75.3% vs. 72.2%, OR 0.85 [95% CI 0.82 to 0.87], p < 0.001) and 90 days (79.6% vs. 78.2%, OR 92 [95% CI 0.89 to 0.95], p < 0.001). Comparison of medical complication rates can be found in Table 2.
Table 2.
Medical complications of allergy and non-allergy patients after shoulder arthroplasty.
| Complication type (days after surgery) | Allergy patients, n (%) (n = 28,182) | Non-allergy patients, n (%) (n = 126,296) | Odds ratio | 95% CI | p Value | ||
|---|---|---|---|---|---|---|---|
| Bleeding complication (30 days) | 135 | (0.5) | 508 | (0.4) | 1.19 | 0.99 to 1.44 | 0.078 |
| Bleeding complication (90 days) | 161 | (0.6) | 575 | (0.5) | 1.26 | 1.05 to 1.50 | 0.012 |
| Sepsis (30 days) | 190 | (0.7) | 558 | (0.4) | 1.53 | 1.30 to 1.80 | <0.001 |
| Sepsis (90 days) | 355 | (1.3) | 934 | (0.7) | 1.71 | 1.51 to 1.94 | <0.001 |
| Surgical site infection (30 days) | 190 | (0.7) | 1026 | (0.8) | 0.83 | 0.71 to 0.97 | 0.019 |
| Surgical site infection (90 days) | 226 | (0.8) | 1339 | (1.1) | 0.89 | 0.78 to 1.01 | 0.087 |
| Medical complication (30 days) | 20,353 | (72.2) | 95,201 | (75.3) | 0.85 | 0.82 to 0.87 | <0.001 |
| Medical complication (90 days) | 22,050 | (78.2) | 100,509 | (79.6) | 0.92 | 0.89 to 0.95 | <0.001 |
Bolded values indicate statistically significant. CI = confidence interval.
The number of patients experiencing surgical complications following TSA was recorded at 30 days and 90 days postoperatively. Patients with allergies were more likely to experience a wound complication within 30 days (0.6% vs. 0.3%, OR 1.89 [95% CI 1.58 to 2.26], p < 0.001) and 90 days (1.0% vs. 0.6%, OR 1.81 [95% CI 1.58 to 2.08], p < 0.001) following surgery. Patients with allergies were also more likely to experience postoperative stiffness following surgery at both 30 days (6.6% vs. 4.4%, OR 1.54 [95% CI 1.46 to 1.63], p < 0.001) and 90 days (10.2% vs. 6.5%, OR 1.64 [95% CI 1.56 to 1.71], p < 0.001). The allergy group also experienced higher rates of PJI (30 days: 0.5% vs. 0.2%, OR 2.10 [95% CI 1.72 to 2.56], p < 0.001; 90 days: 0.7% vs. 0.3%, OR 2.14 [95% CI 1.81 to 2.54], p < 0.001) and implant complications (30 and 90 days: 4.3% vs. 2.9%, OR 1.52 [95% CI 1.42 to 1.62], p < 0.001) at both time points analyzed. Finally, patients with allergies had more total surgical complications within both 30 days (8.29% vs. 5.21%, OR 1.64 [95% CI 1.57 to 1.73], p < 0.001) and 90 days (12.49% vs. 7.67%, OR 1.72 [95% CI 1.65 to 1.79], p < 0.001) of their surgery. Comparison of surgical complication rates can be found in Table 3.
Table 3.
Diagnostic complications of allergy and non-allergy patients after shoulder arthroplasty.
| Complication type (days after surgery) | Allergy patients, n (%) (n = 28,182) | Non-allergy patients, n (%) (n = 126,296) | Odds ratio | 95% CI | p Value | ||
|---|---|---|---|---|---|---|---|
| Wound complication (30 days) | 170 | (0.6) | 404 | (0.3) | 1.89 | 1.58 to 2.26 | <0.01 |
| Wound complication (90 days) | 291 | (1.0) | 723 | (0.6) | 1.81 | 1.58 to 2.08 | <0.01 |
| Postoperative stiffness (30 days) | 1860 | (6.6) | 5531 | (4.4) | 1.54 | 1.46 to 1.63 | <0.01 |
| Postoperative stiffness (90 days) | 2865 | (10.1) | 8175 | (6.5) | 1.64 | 1.56 to 1.71 | <0.01 |
| Joint infection (30 days) | 144 | (0.5) | 308 | (0.2) | 2.1 | 1.72 to 2.56 | <0.01 |
| Joint infection (90 days) | 203 | (0.7) | 426 | (0.3) | 2.14 | 1.81 to 2.54 | <0.01 |
| Implant complication (30 days) | 1206 | (4.3) | 3611 | (2.9) | 1.52 | 1.42 to 1.62 | <0.01 |
| Implant complication (90 days) | 1206 | (4.3) | 3611 | (2.9) | 1.52 | 1.42 to 1.62 | <0.01 |
| Diagnostic complication (30 days) | 2336 | (8.3) | 6575 | (5.2) | 1.64 | 1.57 to 1.73 | <0.01 |
| Diagnostic complication (90 days) | 3521 | (12.5) | 9685 | (7.7) | 1.72 | 1.65 to 1.79 | <0.01 |
Bold indicates statistical significance.
There were 16,982 patients included in the analysis who were described as having a drug allergy. Patients with drug allergies were more likely to require revision surgery at all time points analyzed (30 days: 1.1% vs. 0.6%, OR 1.88 [95% CI 1.59 to 2.20], p < 0.001; 1 year: 2.9% vs. 1.8%, OR 1.56 [95% CI 1.42 to 1.72], p < 0.001; 3 years: 3.9% vs. 2.5%, OR 1.53 [95% CI 1.40 to 1.66]; 5 years: 4.2% vs. 2.8%, OR 1.46 [95% CI 1.35 to 1.59], p < 0.001; 10 years: 3.4% vs. 3.0%, OR 1.39 [95% CI 1.28 to 1.50], p < 0.001) (Supplemental Table 1). Patients with drug allergies were more likely to have sepsis within 30 days (0.8% vs. 0.4%, OR 1.75 [95% CI 1.45 to 2.12], p < 0.001) and 90 days (1.4% vs. 0.7%, OR 1.95 [95% CI 1.69 to 2.25], p < 0.001) postoperatively. Patients with drug allergies were more likely to experience a wound complication within 30 days (0.6% vs. 0.3%, OR 1.81 [95% CI 1.45 to 2.26], p < 0.001) and 90 days (1.1% vs. 0.6%, OR 1.92 [95% CI 1.64 to 2.26], p < 0.001) following surgery. The drug allergy group experienced higher rates of joint infections (30 days: 0.6% vs. 0.2%, OR 2.57 [95% CI 2.06 to 3.21], p < 0.001; 90 days: 0.8% vs. 0.3%, OR 2.51 [95% CI 2.08 to 3.04], p < 0.001) and implant complications (30 and 90 days: 4.9% vs. 2.9%, OR 1.75 [95% CI 1.62 to 1.89], p < 0.001) at both time points analyzed (Supplemental Table 2).
There were 10,106 patients included in the analysis who were described as having an antibiotic allergy. Patients with antibiotic allergies were more likely to require revision surgery at all time points analyzed (30 days: 1.0% vs. 0.6%, OR 1.81 [95% CI 1.47 to 2.23], p < 0.001; 1 year: 2.8% vs. 1.8%, OR 1.49 [95% CI 1.31 to 1.69], p < 0.001; 3 years: 3.9% vs. 2.5%, OR 1.51 [95% CI 1.35 to 1.68]; 5 years: 4.1% vs. 2.8%, OR 1.43 [95% CI 1.29 to 1.59], p < 0.001; 10 years: 4.3% vs. 3.0%, OR 1.36 [95% CI 1.23 to 1.51], p < 0.001) (Supplemental Table 3). Patients with antibiotic allergies were more likely to have sepsis within 30 days (0.8% vs. 0.4%, OR 1.89 [95% CI 1.50 to 2.38], p < 0.001) and 90 days (1.5% vs. 0.7%, OR 2.05 [95% CI 1.73 to 2.44], p < 0.001) postoperatively. Patients with antibiotic allergies were more likely to experience a wound complication within 30 days (0.6% vs. 0.3%, OR 1.83 [95% CI 1.39 to 2.41], p < 0.001) and 90 days (1.1% vs. 0.6%, OR 1.86 [95% CI 1.52 to 2.28], p < 0.001) following surgery. The antibiotic allergy group experienced higher rates of joint infections (30 days: 0.6% vs. 0.2%, OR 2.57 [95% CI 2.06 to 3.27], p < 0.001; 90 days: 0.9% vs. 0.3%, OR 2.60 [95% CI 2.06 to 3.27], p < 0.001) and implant complications (30 and 90 days: 4.9% vs. 2.9%, OR 1.76 [95% CI 1.60 to 1.94], p < 0.001) at both time points analyzed (Supplemental Table 4).
Discussion
There are a paucity of studies investigating the relationship between patient allergies and outcomes in TSA.7,8 While there has not been much work in the area of shoulder arthroplasty, this topic is well documented in hip and knee arthroplasty.9–13 A matched control study by Swartwout et al. found that self-reported allergies by patients prior to hip arthroscopy led to worse patient-reported outcome measures (PROMs) as quantified by Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports (HOS-Sport) and 33-item International Hip Outcome Tool (iHOT-33). 13 In a series of 411 shoulder arthroplasty cases, Elrick et al. found a negative correlation between patient-reported allergies and patient-reported outcomes (PRO) with the number of patient-reported allergies being the most predictive variable for patient satisfaction. 8 The objective of this study is to build on the existing literature correlating the influence of allergies on TSA outcomes by analyzing a large national database of 154,478 patients.
Our study shows that at all time points, patients with allergies have higher rates of revision surgery. Although there has been significant research investigating the link between cause of revisions in TSA and various factors including smoking status, age, gender, BMI and co-morbidities; one factor that has not been thoroughly investigated as a link are patient allergies.14–17 A study by Kennon et al. focused on patient-reported metal allergies on the outcomes of shoulder arthroplasty and found only a 3.8% revision rate for those with metal allergies and an overall favorable outcome for those with allergies. 5 Recent studies have looked at antibiotic allergies and TSA and Bahoravitch et al. found that patients with penicillin allergies had a greater incidence of needing a revision surgery at 2 years postoperatively compared to those without allergies. 6 In our large database study, the incidence of revision was significantly higher for those patients with allergies at 30 days, 90 days, 1 year and 10 years. This may be due to the fact that in patients with allergies there is a consistent baseline inflammatory response. 18 After undergoing a TSA there is a natural inflammatory response that might be heightened in those with pre-existing allergies. This elevated inflammatory response lends patients with allergies to be susceptible to infection, sepsis or post-operative stiffness which in turn necessitates a revision surgery at a higher rate compared to patients without allergies. Since patients with allergies have significantly worse outcomes as seen with the higher revision rate, they should be identified and closely monitored throughout the surgical and post-operative period.
In this study, we found that patients with allergies had a higher odds ratio of developing a peri PJI as well as sepsis. Joint infections are major complications following TSA and can lead to sepsis and therefore any link between allergies and PJI and sepsis must be investigated. 19 Some risk factors that have been investigated as causes for PJI include tobacco usage, prior non-shoulder PJI and depression.20–22 However, the role of allergies in PJI following TSA has not been extensively investigated. A study by Wu et al. in 2020 found that patient-reported penicillin allergy was independently associated with an increased odds of PJI after TSA and TKA and this was further affirmed by a study by Bahorvitch et al. which found an increased odds of PJI within 30 days, 1 year and 2 years post TSA.6,23 A broader study looking at patients with any type of allergy and outcomes in THA and TKA found a significantly higher number of allergies in patients who underwent revision due to an infection. 24 In this study, the odds ratio of developing a PJI in patients with allergies was 2.14 ([1.81 to 2.54], p < 0.01) at 90 days as compared to those with no allergies. Since joint infections are a very serious, potentially life-threatening complication as well as being a high-cost burden, it is important to identify patients with allergies as susceptible to infection and proceed accordingly. 25 Joint infections predispose to sepsis, and this was reflected in our data as patients with allergies had an odds ratio of 1.71 ([1.51 to 1.94], p < 0.01) of having sepsis at 90 days compared to those with no allergies. It is imperative to identify any early signs of PJI in all patients post-operatively, but this study emphasizes the need to pay even closer attention in patients with allergies as they have a much higher risk of developing both PJIs and sepsis.
A less threatening but still important complication that patients with allergies had higher odds of acquiring compared to patients without allergies was postoperative stiffness. Post-operative stiffness has been reported in up to 13% of patients following TSA, indicating a closer evaluation at potential risk factors leading to postoperative stiffness. 26 When looking at the link between allergies and stiffness and other non-infection related complications, there is currently conflicting data in the literature—Elrick et al. found that patient-reported drug and latex allergies negatively affected outcomes including stiffness following shoulder arthroplasty whereas Rosenthal et al. did not find any link between the number of drug allergies on patient outcomes.7,8 Another study by Kennon et al. found no evidence of worse outcomes after TSA in patients with reported metal allergies. 5 Unlike the studies by Rosenthal et al. and Kennon et al., our study found a negative correlation between allergies and postoperative stiffness. Patients with allergies had a significant increase in the odds for postoperative stiffness at 30 and 90 days after TSA. Postoperative stiffness has been associated with lower quality of life and therefore patients with allergies should be informed that this is an adverse outcome that has been associated at higher odds in other patients of similar demographics 27 Another complication for patients with allergies compared to those without was higher odds of having implant complications at 30 and 90 days after TSA. These results are indicating that patients with allergies should be made aware of these worse outcomes prior to TSA and more research needs to be done as to how we can improve outcomes for patients with allergies undergoing TSA in the future.
When looking at specific sub-groups of allergies, both antibiotic allergies and any other drug allergies had a negative impact on outcomes following TSA. Both these groups were more likely to require revision surgery at all time points. Additionally, both groups had higher odds of joint infections, sepsis and implant complications. Antibiotic allergies such as penicillin, have been known to cause a higher rate of revision following TSA as well as adverse outcomes such as PJI, and this study further reinforces that.6,23While there has been conflicting data whether or not drug allergies cause adverse outcomes following TSA in the literature, this study clearly indicates that there is a potential link.7,8 Further prospective research is needed to find the causal pathway between antibiotic and drug allergies to adverse outcomes following TSA.
One of the main limitations of this study is that patients cannot be studied at an individual level and that prevents reporting of patient-level diagnostic information and PRO data. 28 A further limitation of large database studies is that differences in the way that data is collected across registries can cause differing results from similar questions asked from two different databases. 29 While there are some limitations associated with studies such as this, a strength of this study is the very large sample size which allows for a greater power associated with the study as there is a direct positive relationship between sample size and power. 30 Some more strengths of this study is the large sample size leads to inclusion of more diverse patients, completed outcomes, as well as the ability to answer a question relating patient allergies and TSA outcomes as this would be difficult to do with a smaller sample size.30–32
Conclusion
Results from this study indicate that patients with allergies have increased odds of requiring revision surgery following TSA. They were also more likely to have a joint infection, post-operative stiffness, implant related complications as well as sepsis. Since all of these are adverse outcomes shown to decrease quality of life as well as potential life-threatening complications that should be minimized, it is imperative to continue to screen patients for allergies prior to surgery. 27 This would allow high risk patients to be monitored more closely with the aim to limit potential allergy related post operative complications. Future directions include stratifying patients by allergy type to identify which allergies have the most risk for complications; something this paper was unable to do.
Supplemental Material
Supplemental material, sj-docx-1-sel-10.1177_17585732231194615 for The effect of allergies on outcomes following shoulder arthroplasty: A national database analysis of 154,478 patients by Akshar V Patel, Andrew Stevens, Hania Shahzad and Amogh I Iyer, Dashaun Ragland, Gregory Cvetanovich, Julie Y Bishop, Ryan C Rauck in Shoulder & Elbow
Supplemental material, sj-docx-2-sel-10.1177_17585732231194615 for The effect of allergies on outcomes following shoulder arthroplasty: A national database analysis of 154,478 patients by Akshar V Patel, Andrew Stevens, Hania Shahzad and Amogh I Iyer, Dashaun Ragland, Gregory Cvetanovich, Julie Y Bishop, Ryan C Rauck in Shoulder & Elbow
Supplemental material, sj-docx-3-sel-10.1177_17585732231194615 for The effect of allergies on outcomes following shoulder arthroplasty: A national database analysis of 154,478 patients by Akshar V Patel, Andrew Stevens, Hania Shahzad and Amogh I Iyer, Dashaun Ragland, Gregory Cvetanovich, Julie Y Bishop, Ryan C Rauck in Shoulder & Elbow
Supplemental material, sj-docx-4-sel-10.1177_17585732231194615 for The effect of allergies on outcomes following shoulder arthroplasty: A national database analysis of 154,478 patients by Akshar V Patel, Andrew Stevens, Hania Shahzad and Amogh I Iyer, Dashaun Ragland, Gregory Cvetanovich, Julie Y Bishop, Ryan C Rauck in Shoulder & Elbow
Acknowledgments
None.
Footnotes
Contributorship: AVP, AS, HS and RCR designed the study. AVP, AS and HS queried the database and compiled data. AVP, AS, AII and DR drafted the manuscript. AS, AII, GC, JYB and RCR provided important revisions of intellectual content. RCR served as corresponding author. All authors are responsible for the accuracy of the manuscript.
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethical approval: Ethical/IRB approval was not sought for this article because as no human subjects were involved.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
Guarantor: RCR
Informed consent: Informed consent was not sought for this article as all data collected was obtained from a national public de-identified database
Prior Submissions: Selected for a Paper Presentation at International Congress on Shoulder and Elbow Surgery in Rome 9/2023.
ORCID iDs: Hania Shahzad https://orcid.org/0000-0002-1643-0828
Gregory Cvetanovich https://orcid.org/0000-0001-7045-1809
Ryan C. Rauck https://orcid.org/0000-0001-5637-6363
Supplemental material: Supplemental material for this article is available online.
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Supplementary Materials
Supplemental material, sj-docx-1-sel-10.1177_17585732231194615 for The effect of allergies on outcomes following shoulder arthroplasty: A national database analysis of 154,478 patients by Akshar V Patel, Andrew Stevens, Hania Shahzad and Amogh I Iyer, Dashaun Ragland, Gregory Cvetanovich, Julie Y Bishop, Ryan C Rauck in Shoulder & Elbow
Supplemental material, sj-docx-2-sel-10.1177_17585732231194615 for The effect of allergies on outcomes following shoulder arthroplasty: A national database analysis of 154,478 patients by Akshar V Patel, Andrew Stevens, Hania Shahzad and Amogh I Iyer, Dashaun Ragland, Gregory Cvetanovich, Julie Y Bishop, Ryan C Rauck in Shoulder & Elbow
Supplemental material, sj-docx-3-sel-10.1177_17585732231194615 for The effect of allergies on outcomes following shoulder arthroplasty: A national database analysis of 154,478 patients by Akshar V Patel, Andrew Stevens, Hania Shahzad and Amogh I Iyer, Dashaun Ragland, Gregory Cvetanovich, Julie Y Bishop, Ryan C Rauck in Shoulder & Elbow
Supplemental material, sj-docx-4-sel-10.1177_17585732231194615 for The effect of allergies on outcomes following shoulder arthroplasty: A national database analysis of 154,478 patients by Akshar V Patel, Andrew Stevens, Hania Shahzad and Amogh I Iyer, Dashaun Ragland, Gregory Cvetanovich, Julie Y Bishop, Ryan C Rauck in Shoulder & Elbow