Summary

This study is a matched analysis assessing outcomes following arthroscopic rotator cuff repair in patients 65 years and older.

Abstract

Introduction

As the population of the United States ages, there is increasing demand for elective orthopaedic procedures in elderly individuals. One of the more common pathologies affecting elderly patients’ quality of life is rotator cuff pathology. The purpose of this study is to use exact matching of a large national database to assess the safety of performing arthroscopic rotator cuff repair in elderly patients.

Materials And Methods

The ACS NSQIP database was queried to identify patients that underwent arthroscopic rotator cuff repair between December 31, 2015 and January 1, 2017. Patients were split into two age groups: i) between 40-65 years old and ii) 65 years and older. Exact matching was used to control for various potential confounding variables, including sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification score, and various medical comorbidities. After matching, the incidence of various 30-day patient outcome measures were compared between the two groups. Multivariate logistic regression was also used to compare the association of age and short-term outcome measures.

Results

A total of 17,880 patients were included in the study. 69.4% (n=12,404) patients were between 40-65 years old and 30.6% (n=5,476) patients were 65 years and older. After matching, 9,586 patients were included in the final analysis. In the matched analysis, patients 65 years and older were more likely to experience 30-day unplanned readmission (p=0.043) and medical complications (p=0.006), mainly driven by pneumonia (p=0.039) and urinary tract infection (p=0.071). However, there were no significant differences in most 30-day outcome measures, including mortality (p=0.0625), reoperation (p=0.432), non-home discharge (p=0.237), surgical complications (p=0.267), and several medical complications, including myocardial infarction (p=0.118), deep venous thromboembolism (p=0.387), pulmonary embolism (p=0.617), and cerebrovascular accident (p=0.625) between the two age groups.

Conclusions

Generally, arthroscopic rotator cuff repair is safe in appropriately selected patients 65 years and older. However, these older patients are more likely to experience unplanned readmission and pneumonia in the postoperative period. These risks should be considered and discussed with patients prior to proceeding with surgery.