# Low short-term complication rates following acromioclavicular joint surgery: a large database study

## TL;DR

This study finds low short-term complication rates after acromioclavicular joint surgery, but certain health conditions increase the risk.

## Contribution

The study provides novel data on short-term surgical outcomes and identifies risk factors using a large national database.

## Key findings

- Short-term complication rates after AC joint surgery were low at 2.7%.
- Longer operative times and specific comorbidities like COPD and diabetes increased complication risks.
- Preoperative counseling is recommended for patients with risk factors.

## Abstract

Acromioclavicular (AC) joint injuries represent approximately 11% of all shoulder injuries and are managed surgically in severe cases via techniques such as hook-plating, button fixation, and graft-based reconstruction. While much of the existing literature on AC joint surgery points to relatively high rates of long-term complications and reoperations, short-term outcomes are not fully understood. Therefore, this study investigates short-term outcomes following AC joint surgery using a large database to provide comprehensive complication data and elucidate risk factors.

The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2010 to 2023. Patients undergoing surgical intervention for AC joint injuries were identified using Current Procedural Terminology 23550, 23552, and 21320, and their 30-day postoperative outcomes were retrieved. Patients with unknown or null values for demographic or complication metrics were excluded. Statistical analyses included multivariate odds-ratio (OR) logistic regression. Operative time threshold analysis was performed to identify the optimal time cut-point associated with increased complication risk.

A total of 13,117 patients underwent AC joint surgery (average age 49.6 ± 15.2 years; average body mass index 30.1 ± 6.44 kg/m2; 70.5% male). The overall adverse event rate was 2.7%: surgical site infection (1.2%) and return to operating room (1%) were among the most common. An average operating time of 85 ± 56 minutes was determined, and threshold analysis revealed a significant increase (P < .001) in complications for operations lasting longer than 148 minutes. Operative time (OR = 1.01), history of chronic obstructive pulmonary disease (OR = 2.47), steroids (OR = 3.16), dialysis (OR = 5.57), bleeding disorders (OR = 2.67), and type 1 diabetes (OR = 1.61) were all significant risk factors for complications.

AC joint surgery demonstrated relatively low short-term complication rates; however, comorbidities such as type 1 diabetes and chronic obstructive pulmonary disease are linked to a higher risk of experiencing adverse events. Preoperative counseling is recommended for at-risk patients, and future studies should explore surgery-specific operative time and patient management to provide further insights and enhance surgical decision-making.