Risk Factors for Readmission and Revision Surgery Following Rotator Cuff Repair

Abstract

Risk factors for revision surgery and hospitalization following rotator cuff repair (RCR) have not been clearly identified. We hypothesized patient factors and surgeon and hospital volume independently contribute to the risk of readmission within 90 days and revision RCR within one year. Using the SPARCS database, we included patients undergoing primary RCR in New York State between 1997 and 2002. These patients were tracked for readmission within 90 days and revision RCR within 1 year. A generalized estimating equation was developed to determine whether patient factors, surgeon volume, or hospital volume were independent risk factors for the above outcome measures. The total annual number of RCR increased from 6,656 in 1997 to 10,128 in 2002. Ambulatory cases increased from 57% to 82% during this time period. Independent risk factors for readmission within 90 days included increasing age and increased number of comorbidities. Independent risk factors for revision RCR included increasing age, increased comorbidity, and lower surgeon volume. Hospital volume had a minimal effect on either outcome measure. The shift toward out-patient surgery mirrors the shift from open to arthroscopic rotator cuff repair. The finding that surgeon volume is a predictor of revision RCR reflects the findings in other orthopaedic procedures.

Comparative analysis of anatomic and reverse total shoulder arthroplasty: in-hospital outcomes and costs

“…2,28,33,41,45 The complication-based learning curve decreases with experience, with reports identifying this range as 10 to 40 cases. 29,44,55 This is to be expected as surgeon inexperience has been identified as an independent risk factor for poorer shoulder outcomes after rotator cuff repair 46 arthroplasty. 24,47 Hospital surgical caseload volumes may also play a role in the frequency of complications.…”

Effect of Age on Functional and Structural Outcome after Rotator Cuff Repair

“…41 One report mentioned revision surgery after repair, and the independent risk factors included increasing age, increased comorbidity, and lower surgeon's experience. 37 Based on such conflicting results, the question arises whether age really does have an independent effect on the integrity of the repair and whether age independently correlates with functional outcomes. The main drawback of most studies is that they performed univariate analysis that simply noted the correlation between age and outcome.…”

“…19,33,42 The others are case control and correlation studies that evaluated outcomes according to age. However, in these latter studies, the results were rather conflicting; that is, in certain studies a more favorable outcome was seen in younger patients, 3,6,7,32,37 others favored older patients, 41 and yet others advocated that there was no difference. 2,12,29 Therefore, the purpose of the current study was (1) to define various characteristics of rotator cuff tear according to age, (2) to analyze the age difference according to the repair integrity and define whether age is an independent factor of repair integrity, and (3) to evaluate the correlation between age and adjusted functional outcomes of rotator cuff repair.…”

Reliability of the Grading System for Fatty Degeneration of Rotator Cuff Muscles

“…There have been numerous efforts to determine the prognostic factors affecting the outcome of rotator cuff repair, and many structural (tear size, muscle atrophy, fatty degeneration, etc) and clinical factors (age, patients' expectation, and surgeons' experience, etc) have been proposed [2,3,10,14,16,21,24]. Fatty degeneration (FD) of the rotator cuff muscle is one of the factors negatively influencing functional and anatomic outcomes [7,9,[14][15][16].…”