Key result
CIED presence is linked to higher perioperative complication risk after shoulder arthroplasty.
Why the study?
Patients with CIEDs increasingly present for elective orthopedic procedures, but perioperative complications associated with CIED presence required evaluation.
Does the presence of cardiac implantable electronic devices increase the risk of 90-day and 2-year complications in adults undergoing primary total shoulder arthroplasty?
Observational
Does the presence of cardiac implantable electronic devices increase the risk of 90-day and 2-year complications in adults undergoing primary total shoulder arthroplasty?
The presence of a cardiac implantable electronic device, particularly if implanted within 6 months prior to surgery, is associated with increased systemic complications and mortality following total shoulder arthroplasty.
CIED patients warrant careful perioperative management before shoulder arthroplasty, especially recent implants; reinforces consensus from prior observational studies.
Background: Patients with cardiac implantable electronic devices (CIEDs) increasingly present for elective orthopedic procedures. In this study we evaluate peri-operative complications associated with CIED presence using a large multicenter database.Methods: Retrospective cohort analysis was performed using the TriNetX database. Adults undergoing primary total shoulder arthroplasty (TSA) between 2005 and 2025 were identified and stratified by CIED status. Four propensity score-matched (1:1) analyses were conducted: all TSA patients with versus without CIEDs, (2) patients with cardiac disease with CIED versus without CIEDs, and patients with recent device implantation (<6 months before TSA) versus patients with remote device implantation (>6 months before TSA). Matching balanced demographic factors and comorbidities. Outcomes included 90-day and 2-year complications. Relative risks, 95% CIs, and P-values were calculated using chi-square and t-tests; significance was set at P<0.05.Results: After matching, 6,931 patients were included per cohort. CIED presence was associated with significantly higher 90-day rates of cardiac, renal, infectious, and neurologic complications, as well as increased mortality, readmissions, and emergency department visits. These associations persisted after controlling for underlying cardiac disease. Patients undergoing TSA within 6 months of device implantation experienced higher rates of complications. Revision rates were not significantly different between groups, and mechanical outcome associations were variable.Conclusions: CIED presence was associated with increased systemic complications following TSA, particularly when surgery occurred within 6 months of device implantation. Mechanical outcome differences were less consistent. These findings indicate the necessity of multidisciplinary perioperative planning, thoughtful surgical timing, and prospective studies to better define underlying risk pathways.Level of evidence: III.
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Parmar et al. (2026) conducted an observational in Patients undergoing shoulder arthroplasty with or without cardiac implantable electronic devices (CIED). Presence of cardiac implantable electronic device (CIED) vs. Patients without cardiac implantable electronic device was evaluated on Risk of perioperative complications within 90 days following shoulder arthroplasty. Presence of cardiac implantable electronic devices is associated with increased risk of perioperative complications following shoulder arthroplasty.
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