Patient gender and rotator cuff surgery: are there differences in outcome?

Abstract

Background Although rotator cuff syndrome is common and extensively studied from the perspective of producing healed tendons, influence of gender on patient-reported outcomes is less well examined. As activity and role demands may vary widely between men and women, clarity on whether gender is an important factor in outcome would enhance patient education and expectation management. Our purpose was to determine if differences exist in patient-reported outcomes between men and women undergoing rotator cuff surgery. Methods One hundred forty-eight participants (76 W:72 M) aged 35–75 undergoing surgery for unilateral symptomatic rotator cuff syndrome were followed for 12 months after surgery. Demographics, surgical data, and the Western Ontario Rotator Cuff (WORC) scores were collected. Surgery was performed by two fellowship-trained shoulder surgeons at a single site. Results There were no gender-based differences in overall WORC score or subcategory scores by 12 months post-op. Pain scores were similar at all time points in men and women. Women were more likely to have dominant-arm surgery and had smaller rotator cuff tears than men. Complication rates were low, and satisfaction was high in both groups. Conclusion Patient gender doesn’t appear to exert an important effect on patient-reported rotator cuff outcomes in this prospective cohort. Further work examining other covariates as well as the qualitative experience of going through rotator cuff repair should provide greater insight into factors that influence patient-reported outcomes.

Re-Tear Rates Following Rotator Cuff Repair Surgery

“…We found that 55% of those who had a re-tear were female, despite only 37% of the overall cohort of patients undergoing rotator cuff repairs being female. This varies from the findings of other studies that have shown that gender does not play a significant role in the development of rotator cuff injuries [ 24 ].…”

Sex differences in utilization and perioperative outcomes of arthroscopic rotator cuff repair

“…Rather, Wylie et al 50 determined mental health to be more strongly associated with patient-reported outcomes than tear characteristics, and differences in gender-based societal norms concerning pain expression and activity demands have also been postulated as potential influences. 13 , 39 , 41 Thus, though findings of the current study demonstrate significant sex differences in objective measures of total operative time, length of hospital stay, and rates of adverse events among a much larger patient cohort, the underlying factors responsible for such disparities remain to be fully understood.…”

“…Nevertheless, women did achieve greater improvements than males in both scores following surgery, demonstrating the benefit of arthroscopic repair for female patients. In contrast, Sabo et al 41 more recently demonstrated no significant differences in patient-reported pain or function at any timepoint within one year of surgery, though results may have been limited by a smaller sample size. Interestingly, the authors noted women were more likely to undergo rotator cuff repair on the dominant arm, have smaller tear size, and have full rotator cuff repair than men.…”

“…Advances in minimally invasive surgical techniques have allowed surgeons to repair an increasing proportion of rotator cuff tears arthroscopically, and a recent national database study revealed that the volume of total rotator cuff repairs increased by 188% between 2007 and 2015. 14 , 16 Sabo et al 41 studied patient-reported outcomes between men and women undergoing rotator cuff surgery and found no differences in functional outcomes or pain scores within 12 months postoperatively. While this study analyzed sex differences in a small subset of patients undergoing arthroscopic rotator cuff repair, there remains an absence of studies examining this topic utilizing a large, national cohort of patients.…”

Arthroscopic rotator cuff repair: patients with physically demanding work have significantly worse time to return to work, level of employment, and job loss

“…The possible association between gender and ARCR outcomes has been widely studied in the past years. The majority of authors reported no differences between females and males regarding clinical outcomes after arthroscopic surgery of the rotator cuff [14, 28, 29], while Cho et al [7] described faster recovery and less pain among men, and Aagard et al [1] described a long time to RTW in women. In the present study, the influence of gender on the time to RTW, job loss, reduction of the LoE, and change of tasks showed not to be significant in the analyzed outcomes.…”