Abstract
This retrospective cohort study explored the association between preoperative anemia and the risk of revision surgery following total shoulder arthroplasty (TSA). Using the TriNetX database, we analyzed patients aged ≥ 50 years who underwent primary TSA between 2010 and 2024. Patients were classified as anemic (hemoglobin 8–12 g/dL) or non-anemic (≥ 12 g/dL), and propensity score matching was applied in a 1:1 ratio. After matching, 10,838 patients were included (5,419 per group). At three-year follow-up, patients with preoperative anemia demonstrated significantly higher risks of TSA revision (hazard ratio [HR]: 1.58, p < 0.001), periprosthetic joint infection (HR: 1.98, p < 0.001), mortality (HR: 2.65, p < 0.001), pneumonia (HR: 1.66, p < 0.001), and emergency department visits (HR: 1.18, p < 0.001). One-year results showed consistent trends, with mortality risk being notably higher (HR: 3.29 vs. 2.65). Sensitivity analyses restricted to academic medical centers, patients with minimum three-year survival, and individuals with mild anemia consistently reinforced these findings. A validation cohort from the pre-COVID-19 era confirmed the associations. These findings suggest that preoperative anemia may represent an opportunity for risk stratification and optimization following TSA. Whether preoperative correction of anemia can reduce these risks warrants investigation in prospective interventional studies.
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Data availability
The data utilized in this research were derived from the TriNetX global federated research network, which provides access to de-identified electronic medical records from participating healthcare organizations. Due to licensing agreements and privacy regulations, the dataset cannot be shared publicly. Researchers interested in reproducing or extending this analysis may contact the corresponding author for information on obtaining TriNetX access and constructing a comparable cohort under institutional authorization.
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Data Availability Statement:
The data utilized in this research were derived from the TriNetX global federated research network, which provides access to de-identified electronic medical records from participating healthcare organizations. Due to licensing agreements and privacy regulations, the dataset cannot be shared publicly. Researchers interested in reproducing or extending this analysis may contact the corresponding author for information on obtaining TriNetX access and constructing a comparable cohort under institutional authorization.
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The conception and design of the study were jointly developed by Kuo-Chuan Hung and Li-Chen Chang, who also contributed to the methodological framework and software implementation. Data curation was performed by Kuo-Chuan Hung. Visualization and investigation were carried out by Yi-Chen Lai and Kuo-Chuan Hung, while supervision was provided by Yi-Chen Lai and I-Wen Chen. Validation and additional software support were undertaken by Kuo-Chuan Hung. The initial manuscript draft was prepared by Kuo-Chuan Hung and I-Wen Chen, who also contributed to critical review and editing of the final version. All authors have read and approved the submitted manuscript.
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This study was a retrospective analysis conducted using data from the TriNetX Analytics Network. It was performed in accordance with the principles of the Declaration of Helsinki and approved by the Institutional Review Board of Chi Mei Medical Center, which granted a waiver for informed consent.
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Hung, KC., Chang, LC., Lai, YC. et al. Association between preoperative anemia and revision risk after total shoulder arthroplasty: a multi-institutional cohort study. Sci Rep (2026). https://doi.org/10.1038/s41598-026-43405-y
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DOI: https://doi.org/10.1038/s41598-026-43405-y
