Shoulder
Risk factors for surgical complications in rotator cuff repair in a veteran population

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Background

Technical advances have allowed arthroscopic rotator cuff repair to supplant open repairs with similar outcomes. However, few data exist to support the theoretical decrease in complications with the arthroscopic technique.

Methods

We used the Veterans Administration Surgical Quality Improvement Program database from the entire U.S. Veterans Administration system. We obtained perioperative data of all patients undergoing rotator cuff repair between 2003 and 2008. Single and multivariate analyses were performed to evaluate risk factors for perioperative complications associated with rotator cuff surgery.

Results

There were 6975 open rotator cuff repairs and 2918 arthroscopic rotator cuff repairs performed with similar patient age, gender breakdown, body mass index, and comorbidities. Complications occurred in the early postoperative period in 2.1% of the open repair group and 0.9% of the arthroscopic repair group (P < .0001). The prevalence of both superficial and deep wound infection was higher in the open group compared with the arthroscopic group (1% vs. 0.1% superficial, P < .0001; 0.3% vs. 0.1% deep, P = .11). Return to the operating room within the 30-day surveillance period occurred in 1.1% of the open repair patients compared with 0.5% of patients undergoing arthroscopic repairs (P < .0001). -Multivariate logistic regression analysis revealed that the arthroscopic group had a significantly lower risk of complications (P = .0001), a lower rate of superficial infection (P = .0002), a lower incidence of return to the operating room within 30 days (P = .007), and a lower risk of hospital readmission (P < .0001).

Conclusion

Arthroscopic rotator cuff repair in the veteran population resulted in a lower incidence of perioperative complications compared with open repair.

Section snippets

Methods

The VASQIP collects morbidity and mortality data from surgical procedures at VA surgical programs nationwide.5 The overall goal is to measure and to improve the quality of surgical care by studying data from multiple centers as well as to provide estimates of procedural risk based on a large data sample. Each hospital has specifically identified personnel who are tasked with chart review and entry of data from all surgical patients.

We queried the VASQIP data from 2003 to 2008 for patients

Results

During the 5-year period spanning 2003 to 2008, there were 6975 open rotator cuff repairs and 2918 arthroscopic cuff repairs (Table I). During this period, the number of arthroscopic cases increased each year, from 131 performed in 2003, to 427 in 2005, up to 737 in 2008. In the open surgery cohort, there were 6655 men and 320 women, with an average age of 58.3 years (range, 22-90 years). The mean body mass index in this group was 29.8, with a large range from 14 to 177. In comparison, the

Discussion

Complications after open and arthroscopic shoulder surgery include infection, stiffness/fibrous ankylosis, neurologic injury, deep venous thrombosis, suture anchor failure, and rerupture.7, 16, 20 Deep infection is not common, reported to occur in between 1% and 2% of rotator cuff repairs.2, 15 Athwal et al reported on a group of 39 cases of deep infection after rotator cuff repair, but only 3 of these were performed arthroscopically. Abrams noted that the incidence of infection after

Conclusions

This study showed lower postoperative morbidity events in the arthroscopically treated group of VA patients with rotator cuff tears compared with those treated with open rotator cuff repair. These are clinically relevant data that can be used in surgical decision-making in patients with comorbidities that could be contributory to poor outcomes with open surgery and provide support for the use of minimally invasive techniques in the veteran population. With decreased 30-day return to operating

Disclaimer

Brett D. Owens is a paid consultant for Mitek Sports Medicine and Musculoskeletal Transplant Foundation. All the other authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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The findings reported in the publication were derived, in whole or in part, from activities constituting research as described in VHA Handbook 1058.05.

The opinions expressed are those of the authors and not necessarily those of the Department of Veterans Affairs or the United States Government.

This study was approved by the IRB at Bay Pines VA Healthcare System, Bay Pines, FL, USA.

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