Elevated alkaline phosphatase independently predicts early postoperative complications in noninfectious revision total shoulder arthroplasty

Purpose: This study investigates the association between preoperative serum alkaline phosphatase levels and 30 day postoperative complications following noninfectious revision total shoulder arthroplasty (TSA). We hypothesize that elevated alkaline phosphatase levels are significantly associated with an increased 30 day postoperative complication rate. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent noninfectious revision TSA from 2015 to 2022. The study population was divided into two groups based on preoperative serum alkaline phosphatase: normal (44–147 IU/L) and elevated (> 147 IU/L). Logistic regression analysis was conducted to investigate the relationship between elevated alkaline phosphatase levels and postoperative complications. Results: Compared to normal levels, elevated alkaline phosphatase was independently associated with a significantly greater likelihood of experiencing any complications (odds ratio [OR] 2.54, 95% confidence interval [CI] 1.41–4.55; P =.002), sepsis (OR 9.96, 95% CI 1.67–59.29; P =.012), blood transfusions (OR 3.77, 95% CI 1.48–9.61; P =.005), readmission (OR 3.65, 95% CI 1.48–9.01; P =.005), and length of stay > 2 days (OR 2.37, 95% CI 1.31–4.30; P =.004). Conclusions: Elevated preoperative alkaline phosphatase was associated with a greater rate of early postoperative complications following noninfectious revision TSA. Level of Evidence: Level III; Retrospective Cohort Comparison; Prognosis Study.