2019 ISAKOS Biennial Congress ePoster #2027
Do Patient Characteristics Implicated by Basic Science Predict Rotator Cuff Repair Revision Surgery?
Evan A. O'Donnell, MD, New York, NY UNITED STATES
Michael C. Fu, MD, MS, New York, NY UNITED STATES
William Schairer, MD, New York, NY UNITED STATES
Samuel A. Taylor, MD, New York, NY UNITED STATES
Joshua S. Dines, MD, Uniondale, NY UNITED STATES
David M. Dines, MD, Uniondale, NY UNITED STATES
Russell F. Warren, MD, New York, NY UNITED STATES
Lawrence V. Gulotta, MD, Chappaqua, NY UNITED STATES
The Hospital for Special Surgery, New York, NY, UNITED STATES
FDA Status Not Applicable
While overall comorbidity burden was not associated with revision RCR, certain patient characteristics including smoking, obesity, hyperlipidemia, and Vitamin-D deficiency predicted revision surgery.
Rotator cuff repair (RCR) failure remains a difficult clinical scenario. Studies of the biomechanical properties of RCR, tendon-to-bone healing, and patient-reported outcomes have identified patient characteristics that predict poor outcomes after RCR. These factors include a history of smoking, diabetes mellitus (DM), obesity, hyperlipidemia (HLD), vitamin-D deficiency and osteoporosis. There remains, however, a paucity of literature investigating if these patient characteristics can be used to predict revision RCR after failure. Herein, we describe the rate of revision RCR as well as those patient characteristics that can be used to predict this outcome.
A national insurance database was searched from 2007 to 2016 for all patients who underwent RCR. Current Procedural Terminology (CPT) were used to identify RCRs. Laterality modifiers for the primary surgery were used to identify subsequent revision RCRs. Basic demographics were recorded. International Classification of Diseases Ninth Revision (ICD-9) codes were used to identify salient patient characteristics including Charlson Comorbidity Index (CCI), smoking status, DM, obesity, hyperlipidemia, vitamin-D deficiency and osteoporosis. Patient age was described from 0-59, 60-69, 70-74, and 75+ years old. Dichotomous data were analyzed with chi-squared testing. Multivariable logistic regression was used to predict revision RCR.
Included in the study were 41,467 patients (41,844 shoulders) who underwent primary arthroscopic RCR. Of all arthroscopic RCRs, 3,072 patients (3,463 shoulders) underwent revision RCR (8.38%). The average time from primary RCR to revision was 414.9 days (median 214.0 days). Increasing age and male sex were significantly predictive of revision RCR. Of modifiable patient characteristics, smoking most strongly predicted revision RCR (OR 1.36, p < 0.001). Obesity, hyperlipidemia, and vitamin-D deficiency also increased risk of revision RCR significantly. Diabetes mellitus was found to be protective against revision surgery (OR 0.84, p < 0.001). Overall comorbidity burden as measured by the CCI was not predictive of revision RCR.
The rate of revision RCR was over 8%. The average revision RCR occurred 1 year after the primary surgery. Increasing age and male gender were predictive of revision RCR. The overall comorbidity burden was not predictive of revision RCR, whereas discrete factors identified by orthopaedic literature were. Of these modifiable patient characteristics, smoking was the strongest predictor. Obesity, hyperlipidemia and vitamin-D deficiency were also predictive of revision RCR, whereas DM was found to be protective against subsequent surgery. This study validates previous basic science orthopaedic literature and quantifies which comorbidities are predictive or protective against revision RCR.