Summary

Pre-operative patient resilience correlated with pre-operative ASES score, and resilience at 2-year follow-up correlated with ASES score improvement.

Abstract

Background

Patient resilience, defined by an ability to bounce back or recover from stress, was previously reported to correlate with outcomes after total shoulder arthroplasty. However, it is unclear whether this relationship exists for other orthopaedic procedures. This study sought to evaluate the relationship between pre-operative patient resilience and post-operative surgical outcomes in patients undergoing rotator cuff repair (RCR).

Methods

Patients who underwent RCR in 2020 were identified from a single multicenter institution using CPT codes. Patients undergoing primary RCR who completed the Brief Resilience Scale (BRS) pre-operatively through our standard patient reported outcome data analysis were considered for inclusion. Patients with less than 2-year follow-up, irreparable rotator cuff tears, or significant concomitant surgery (ex: labral repair, capsular release for adhesive capsulitis) were excluded. A chart review was conducted to collect demographic variables including pre-operative sports participation, mental health conditions, rotator cuff tear size, and concomitant procedures. Two-year follow-up was collected, including the American Shoulder and Elbow Surgeons (ASES) survey, the Single Assessment Numeric Evaluation (SANE) survey, the BRS, and complications. Outcomes were compared between patients with low resilience (LR), normal resilience (NR), and high resilience (HR) as previously defined.

Results

Overall, 156 patients were eligible for inclusion, and 100 patients (52 male, 48 female) with an average age of 60±9 years completed the follow-up survey and were included in this study. Patients in the LR group had significantly higher rates of anxiety and depression than patients in the NR and HR groups. Resilience scores were not constant over time, with 39% of patients switching resilience groups at 6-month follow-up and 38% of patients switching resilience groups at 2-year follow-up. Pre-operative ASES scores were significantly different between the groups, with the LR group having the lowest scores (35.0±19.1) and HR patients having the highest scores (53.6±20.1). There were no significant differences in post-operative outcomes between groups, including reoperation rate, ASES score, change in ASES score, and SANE score. Patients with higher pre-operative resilience without a history of anxiety and/or depression had improved SANE scores relative to patients with lower pre-operative resilience (p=0.019). Multivariate analysis found that resilience at 2-year follow-up was significantly related to ASES score improvement (estimate=6.41, p=0.031).

Conclusions

Pre-operative patient resilience correlated with pre-operative ASES score, and resilience at 2-year follow-up correlated with ASES score improvement. When excluding patients with anxiety/depression, patients with low resilience were found to have worse post-operative SANE scores. Additionally, patient resilience was not static; over half of the patients with low pre-operative resilience were found to have normal or high post-operative resilience.