Abstract
BACKGROUND: This retrospective database study evaluates postoperative complications following total shoulder arthroplasty (TSA) in patients with non-alcoholic cirrhosis (NAC) versus non-alcoholic fatty liver disease (NAFLD) using a large matched national cohort. MATERIALS AND METHODS: Among 266,263 patients who underwent TSA, 171,059 had continuous enrollment and were undergoing TSA for the first time. Out of this group, 1986 patients had NAC and 4240 had NAFLD. Propensity-score matching was conducted controlling for age, sex, Charlson Comorbidity Index, and key clinical covariates, resulting in a final cohort of 2170 total patients (1085 per group). Multivariable logistic regression was used to compare 90-day and one-year postoperative complication rates. RESULTS: Within 90 days postoperatively, patients with NAC had higher rates of acute kidney injury, blood transfusion, and any complication compared to patients with NAFLD. At one year, NAC patients continued to show higher odds of blood transfusion and overall complications, while NAFLD patients had significantly higher deep vein thrombosis incidence. DISCUSSION: Patients with NAC undergoing TSA are at increased risk for postoperative complications compared to those with NAFLD. Although NAFLD patients had fewer adverse outcomes, they exhibited elevated thromboembolic risk at one year. Tailored perioperative strategies to liver disease subtype patients are needed to help mitigate postoperative complications in this vulnerable population.