The effects of obesity on 1-year functional outcomes after arthroscopic rotator cuff tear repair

Gambhir, Neil; Shankar, Dhruv S.; Alben, Matthew G.; Kwon, Young W.; Rokito, Andrew S.; Virk, Mandeep S.

doi:10.1016/j.jseint.2022.04.004

Cited by 11 publications

(13 citation statements)

References 22 publications

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“…Overall, 6 studies reported follow-up pain scores. Out of these, five assessed pain using the visual analogue scale (VAS) [ 17 – 19 , 25 , 27 ] and one using the PROMIS pain interference scale [ 23 ]. In both these scales, a higher score indicates greater pain intensity [ 28 , 29 ].…”

Section: Resultsmentioning

confidence: 99%

Impact of obesity on outcomes of rotator cuff repair: A systematic review and meta-analysis

Ma,

Shen,

Wan

2024

PLoS ONE

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Background To synthesize the existing evidence on the association between obesity and rotator cuff repair outcomes such as pain, shoulder function, range of motion, and complications. Methods We searched PubMed, EMBASE, and Scopus databases for relevant observational studies (cohort and case-control) and randomized controlled trials (RCTs). The target population in the included studies comprised adults who had undergone rotator cuff repair procedures. The outcomes of interest were functional outcomes (such as range of motion), pain scores, patient-reported outcome measures, and complication rates (such as re-repair and readmission rates). We applied random-effects models and calculated pooled effect sizes reported as standardized mean differences (SMDs) or relative risks (RRs) with 95% confidence intervals. Results We analysed data from 11 studies. In most, the follow-up periods ranged from 12 to 60 months. Obese individuals experienced greater pain (SMD 0.30; 95% CI, 0.10, 0.50) and lower shoulder function (SMD -0.33; 95% CI, -0.54, -0.12) than other individuals in the long-term post-operative follow-up. Obese individuals also had higher risks of complications (RR 1.48; 95% CI, 1.11, 1.98) and readmission (RR 1.35; 95% CI, 1.27, 1.43), but a similar likelihood of re-repair (RR, 1.27; 95% CI, 0.82, 1.95) than non-obese/normal BMI individuals. While the forward flexion and external rotation functions were comparable, obese individuals displayed less internal rotation function than other individuals (SMD -0.59; 95% CI, -0.87, -0.30). Conclusion Obesity was associated with unfavourable outcomes after rotator cuff surgery, including increased pain, reduced shoulder function, high risks of complications, and readmission. These findings emphasize the importance of addressing obesity-related factors to improve post-operative outcomes.

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Section: Resultsmentioning

confidence: 99%

Impact of obesity on outcomes of rotator cuff repair: A systematic review and meta-analysis

Ma,

Shen,

Wan

2024

PLoS ONE

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“…Due to the inherent diferences that can arise using anchor-based methods based on study questions or design, inter-study variability is to be anticipated for clinical benchmark values [20,42]. that lower baseline scores were a signiicant factor associated with achievement of MCID (p < 0.001) [19]. Previously unreported using adequately powered ROC-evaluated values of the MCID and SCB for PROMIS UE and pain instruments, our study sought to establish these benchmarks and assess the interplay of multiple factors associated with their attainment.…”

Section: Discussionmentioning

confidence: 99%

“…The study by Haunschild et al lacked a sufficient sample size to calculate the MCID by an anchor‐based means (AUC of 0.597), only reporting on the distribution‐based MCID (4.87) and an anchor‐based SCB of 7.95 (AUC 0.760) [22]. Furthermore, they only noted that lower baseline scores were a significant factor associated with achievement of MCID ( p < 0.001) [19]. Previously unreported using adequately powered ROC‐evaluated values of the MCID and SCB for PROMIS UE and pain instruments, our study sought to establish these benchmarks and assess the interplay of multiple factors associated with their attainment.…”

Section: Discussionmentioning

confidence: 99%

“…Higher BMI was found to be negatively associated with achieving the SCB for PROMIS Pain instruments ( p = 0.01). Obesity has been shown to negatively impact aRCR operative time, length of postoperative hospitalization, and PROMs [4, 6, 19, 48]. While no difference in outcomes has been reported in respect to the dominant arm undergoing aRCR, involvement of the dominant arm ( p = 0.03) was associated with patients achieving the UE SCB [27].…”

Section: Discussionmentioning

confidence: 99%

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Minimal clinically important difference (MCID) and substantial clinical benefit (SCB) of upper extremity PROMIS scores following arthroscopic rotator cuff repairs

Alben

Gordon

Gambhir

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeTo calculate and determine what factors are associated with achieving the Minimal Clinically Important Difference (MCID) and the Substantial Clinical Benefit (SCB) of Patient‐Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Testing v2.0 (UE), Pain Interference (P‐Interference), and Pain Intensity (P‐Intensity) in patients undergoing arthroscopic rotator cuff repair (aRCR). MethodsThe change in PROMIS scores representing the optimal cutoff for a ROC curve with an area under the curve analysis was used to calculate the anchor‐based MCID and SCB. To assess the responsiveness of each PROM, effect sizes and standardized response means (SRM) were calculated. To identify factors associated with attaining the MCID and SCB, univariate and multivariate logistic regression analyses were performed. ResultsA total of 323 patients with an average age of 59.9 ± 9.5 were enrolled in this study, of which, 187/323 [57.9%] were male and 136/323 [42.1%] were female. The anchor‐based MCID for PROMIS UE, P‐Interference, and P‐Intensity was: 9.0, 7.5, and 11.2, respectively. The respective SCB was 10.9, 9.3, and 12.7. Effect size and SRM were: PROMIS UE (1.4, 1.3), P‐Interference (1.8, 1.5), and P‐Intensity (2.3, 2.0). Lower preoperative P‐Intensity scores (p = 0.02), dominant arm involvement (p = 0.03), and concomitant biceps tenodesis (p = 0.03) were associated with patients achieving the SCB for PROMIS UE. ConclusionA large responsiveness for each of the PROMIS instruments due to the majority of patients reporting great improvement after aRCR and a small standard deviation across all outcome measures was shown in our study. Lower preoperative P‐Intensity scores and concomitant biceps tenodesis were associated with higher odds of achieving the SCB for PROMIS UE. The knowledge of MCID and SCB values for PROMIS instruments will allow the surgeon to determine whether the improvements in the PROMIS scores after aRCR are clinically meaningful. Level of evidenceLevel III.

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“…The effects of high BMI, diabetes mellitus, and dyslipidaemia have been previously studied with varied findings. Several studies found that these variables predict worse clinical outcomes, recovery, and tendon healing following rotator cuff injury [ 30 , 31 , 32 , 33 ]. Conversely, other studies demonstrated no association of BMI with post-operative outcome scores following ARCR [ 29 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Approaching Artificial Intelligence in Orthopaedics: Predictive Analytics and Machine Learning to Prognosticate Arthroscopic Rotator Cuff Surgical Outcomes

Potty

Potty²,

Maffulli

et al. 2023

JCM

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Machine learning (ML) has not yet been used to identify factors predictive for post-operative functional outcomes following arthroscopic rotator cuff repair (ARCR). We propose a novel algorithm to predict ARCR outcomes using machine learning. This is a retrospective cohort study from a prospectively collected database. Data were collected from the Surgical Outcome System Global Registry (Arthrex, Naples, FL, USA). Pre-operative and 3-month, 6-month, and 12-month post-operative American Shoulder and Elbow Surgeons (ASES) scores were collected and used to develop a ML model. Pre-operative factors including demography, comorbidities, cuff tear, tissue quality, and fixation implants were fed to the ML model. The algorithm then produced an expected post-operative ASES score for each patient. The ML-produced scores were compared to actual scores using standard test-train machine learning principles. Overall, 631 patients who underwent shoulder arthroscopy from January 2011 to March 2020 met inclusion criteria for final analysis. A substantial number of the test dataset predictions using the XGBoost algorithm were within the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) thresholds: 67% of the 12-month post-operative predictions were within MCID, while 84% were within SCB. Pre-operative ASES score, pre-operative pain score, body mass index (BMI), age, and tendon quality were the most important features in predicting patient recovery as identified using Shapley additive explanations (SHAP). In conclusion, the proposed novel machine learning algorithm can use pre-operative factors to predict post-operative ASES scores accurately. This can further supplement pre-operative counselling, planning, and resource allocation. Level of Evidence: III.

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The effects of obesity on 1-year functional outcomes after arthroscopic rotator cuff tear repair

Cited by 11 publications

References 22 publications

Impact of obesity on outcomes of rotator cuff repair: A systematic review and meta-analysis

Impact of obesity on outcomes of rotator cuff repair: A systematic review and meta-analysis

Minimal clinically important difference (MCID) and substantial clinical benefit (SCB) of upper extremity PROMIS scores following arthroscopic rotator cuff repairs

Approaching Artificial Intelligence in Orthopaedics: Predictive Analytics and Machine Learning to Prognosticate Arthroscopic Rotator Cuff Surgical Outcomes

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