Researchers zeroed in on the patient characteristics and comorbidities that are associated with the need for revision rotator cuff repair in a new study published in the journal Arthroscopy.
Smoking Linked to Revision Rotator Cuff Repair
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#obesity#rotatorcuffrepairSecondary#smoking
In “The Effect of a Patient Characteristics and Comorbidities on the Rate of Revision Rotator Cuff Repair,” published in the September issue of the journal, they found that smoking, obesity, vitamin D deficiency, and hyperlipidemia were independent risk factors for failure of primary rotator cuff repair requiring revision rotator cuff repair.
Contrary to other studies though, diabetes mellitus (DM), osteoporosis and overall comorbidity burden as measured by the Charlson Comorbidity Index were not.
The purpose of the study was to analyze the national rate of failed primary rotator cuff repair requiring revision repair. The patient characteristics used in the analysis were smoking history, diabetes mellitus, hyperlipidemia, vitamin D deficiency and osteoporosis.
Data was collected from a combined public and private national insurance database on all patients who underwent rotator cuff repair between 2007 and 2016.
Laterality modifiers for the primary surgery were used to identify subsequent revision rotator cuff repairs. All patients who didn’t have a linked laterality modifier for the Rotator Cuff Repair Current Procedural Terminology code were excluded from the study. International Classification of Diseases Ninth Revision codes were used to identify patient characteristics including Charlson Comorbidity Index, smoking status, DM, obesity, hyperlipidemia, vitamin D deficiency, and osteoporosis. Patient ages were categorized as <60, 60-69, 70-74, or 75+ years old.
Overall, the study included 41,467 patients and 41,844 shoulders. Slightly more than half of all patients were male. Out of the 41,467 patients, 3,072 required revision rotator cuff repair. Almost 39% of all the patients were between the ages of 60 and 69 years. Almost 38% of those who needed a revision were of the same age.
The average time from the primary surgery to the revision was 414.9 days. Increasing age and the male sex were also predictive (odds ratio [OR] 1.10, p = .019, 95% confident interval [CI] 1.02-1.19)
Diabetes mellitus was found to be protective against revision surgery (OR 0.84, p < .001, CI 0.76-0.92).
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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