Outpatient Rotator Cuff Repair Less Risky Than Inpatient?

According to a new study, arthroscopic rotator cuff repair performed outpatient has less of a risk of 90-day postoperative complications than when it is an inpatient procedure.

In the study, “Inpatient Arthroscopic Rotator Cuff Repair is Associated with Higher Postoperative Complications Compared to Same-Day Discharge: A Matched Cohort Analysis,” published online in the journal Arthroscopy on July 25,2020, researchers compared 90-day postoperative complications between outpatient and inpatient arthroscopic rotator cuff repairs.

The study included 2,812 patients who underwent arthroscopic rotator cuff repair from 2007 and 2015. Patients were categorized based on length of hospital stay with inpatient rotator cuff repair defined as patients with one or more days in the hospital. Outpatient rotator cuff repair was defined as same day discharge.

The researchers compared patient factors, concomitant procedures, total adverse events (TAE), medical adverse events (MAE), and surgical adverse events (SAE) between the two groups who were matched based on age, sex, Charlson comorbidity index (CCI) and medical comorbidities.

According to the data collected, the 90-day postoperative incidence of total adverse events (8.9% vs. 3.6%; p < 0.0001), surgical adverse events (2.7% vs. 0.9%; p = 0.0002), and medical adverse events (6.4% vs. 3.0%; p < 0.0001) were higher for the inpatient rotator cuff repair group.

Inpatient rotator cuff repair with a length of stay of one day or more, higher Charlson comorbidity index, and anxiety or depression were independent predictors for total adverse events after arthroscopic rotator cuff repair. For surgical adverse events, the independent predictors were open biceps tenodesis and inpatient rotator cuff repair. The most important predictors for medical adverse events within 90 days were higher Charlson comorbidity index, anxiety or depression, and inpatient rotator cuff repair.

The researchers wrote, “Inpatient arthroscopic rotator cuff repair is associated with increased risk of 90-day postoperative complications compared to outpatient. However, there is no difference for all-cause or pain-related EDV within 90 days after surgery. Additionally, the multivariate model identified inpatient rotator cuff repair, higher Charlson comorbidity index, and diagnosis of anxiety or depression as independent risk factors for 90-day total adverse events after arthroscopic rotator cuff repair.”