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Eng E, Mowers C, Sachdev D, Yerke-Hansen P, Jackson GR, Knapik DM, Sabesan VJ. Despite an Advanced Readability for the General Population, ChatGPT-3.5 Can Effectively Supplement Patient-Related Information Provided by the Treating Surgeon Regarding Common Questions About Rotator Cuff Repair. Arthroscopy 2024:S0749-8063(24)00369-4. [PMID: 38777000 DOI: 10.1016/j.arthro.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/23/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE The purpose of this study was to investigate the accuracy of ChatGPT's responses to frequently asked questions (FAQ) prior to rotator cuff repair surgery. METHODS The ten most common FAQs related to rotator cuff repair were compiled from four institution websites. Questions were then input into ChatGPT-3.5 in one session. The provided ChatGPT-3.5 responses were analyzed by two orthopedic surgeons for reliability, quality, and readability using The Journal of the American Medical Association (JAMA) Benchmark criteria, the DISCERN score, and the Flesch-Kincaid Grade Level. RESULTS The JAMA Benchmark criteria score was 0, indicating the absence of reliable source material citations. The mean Flesch-Kincaid Grade Level was 13.4 (range, 11.2-15.0). The mean DISCERN score was 43.4 (range, 36-51) indicating that the quality of the responses overall was considered fair. All responses cited making final decision-making to be made with the treating physician. CONCLUSION ChatGPT-3.5 provided substandard patient-related information in alignment with recommendations from the treating surgeon regarding common questions around rotator cuff repair surgery. Additionally, the responses lacked reliable source material citations and the readability of the responses was relatively advanced with a complex language style. CLINICAL RELEVANCE The findings of this study suggest that ChatGPT-3.5 may not effectively supplement patient-related information in the context of recommendations provided by the treating surgeon prior to rotator cuff repair surgery.
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Affiliation(s)
- Emma Eng
- Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Colton Mowers
- Rush University Medical College, Chicago, IL 60612, USA
| | | | - Payton Yerke-Hansen
- Department of Orthopaedic Surgery, Louisiana State University Health -Shreveport, Shreveport, LA 71103, USA
| | - Garrett R Jackson
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO 65212, USA.
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, Chesterfield, MO, USA
| | - Vani J Sabesan
- HCA JFK/University of Miami Miller School of Medicine Orthopaedic Residency Program Palm Beach, FL, Lake Worth, FL 33463, USA
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Andrea Stefano M, Salerno M, Mondini Trissino da Lodi C, Gonalba GC, Candrian C, Filardo G. The influence of sex is a neglected focus in rotator cuff repair: A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38678392 DOI: 10.1002/ksa.12201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 04/30/2024]
Abstract
PURPOSE Rotator cuff (RC) disorders are the most common cause of shoulder disability. The aim of this study was to quantify the evidence on the sex-related differences in RC repair. METHODS A systematic review of the literature was performed in January 2023 in PubMed, Wiley Cochrane Library and Web of Science on research articles on humans with RC tears treated surgically. A meta-analysis was performed to compare results in men and women. The Downs and Black score and the modified Coleman methodology score (MCMS) were used to assess the retrieved studies. RESULTS A total of 39,909 patients were enroled in the 401 studies analysed (45% women, 55% men). A trend toward more sex-balanced recruitment was observed over time. Only 4% of the studies on 1.5% of the documented patients presented disaggregated outcome data and were quantitatively analysed. A tendency for lower range of motion values after surgery was found for external shoulder rotation in women, with 39.9° ± 6.9° versus 45.3° ± 4.1° in men (p = 0.066). According to Downs and Black scores, four studies were good and 12 fair, with a main MCMS score of 69/100. CONCLUSION There is a lack of awareness on the importance to document women- and men-specific data. Only 4% of the articles disaggregated data, and it was possible to analyse only 1.5% of the literature population, a sample which cannot be considered representative of all patients. The lack of disaggregated data is alarming and calls for action to better study men and women differences to optimise the management of RC tears. This will be necessary to provide sex-specific information that could be of clinical relevance when managing RC repair. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Manuela Salerno
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | | | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Shi BY, Sriram V, Wu SY, Huang D, Cheney A, Metzger MF, Sundberg O, Lyons KM, McKenna CE, Nishimura I, Kremen TJ. Novel bisphosphonate-based cathepsin K-triggered compound targets the enthesis without impairing soft tissue-to-bone healing. Front Bioeng Biotechnol 2024; 12:1308161. [PMID: 38433822 PMCID: PMC10905384 DOI: 10.3389/fbioe.2024.1308161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Background: Osteoadsorptive fluorogenic sentinel 3 (OFS-3) is a recently described compound that contains a bone-targeting bisphosphonate (BP) and cathepsin K (Ctsk)-triggered fluorescence signal. A prior study in a murine Achilles repair model demonstrated its effectiveness at targeting the site of tendon-to-bone repair, but the intrinsic effect of this novel bisphosphonate chaperone on tendon-to-bone healing has not been previously explored. We hypothesized that application of this bisphosphonate-fluorophore cargo conjugate would not affect the biomechanical properties or histologic appearance of tendon-bone repairs. Materials and Methods: Right hindlimb Achilles tendon-to-bone repair was performed on 12-week old male mice. Animals were divided into 2 groups of 18 each: 1) Achilles repair with OFS-3 applied directly to the repair site prior to closure, and 2) Achilles repair with saline applied prior to closure. Repaired hindlimbs from 12 animals per group were harvested at 6 weeks for biomechanical analysis with a custom 3D-printed jig. At 4 and 6 weeks, repaired hindlimbs from the remaining animals were assessed histologically using H&E, immunohistochemistry (IHC) staining for the presence of Ctsk, and second harmonic generation (SHG) imaging to evaluate collagen fibers. Results: At 6 weeks, there was no significant difference in failure load, stiffness, toughness, or displacement to failure between repaired hindlimbs that received OFS-3 versus saline. There was no difference in tissue healing on H&E or Ctsk staining on immunohistochemistry between animals that received OFS-3 versus saline. Finally, second harmonic generation imaging demonstrated no difference in collagen fiber parameters between the two groups. Conclusion: OFS-3 did not significantly affect the biomechanical properties or histologic appearance of murine Achilles tendon-to-bone repairs. This study demonstrates that OFS-3 can target the site of tendon-to-bone repair without causing intrinsic negative effects on healing. Further development of this drug delivery platform to target growth factors to the site of tendon-bone repair is warranted.
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Affiliation(s)
- Brendan Y. Shi
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, United States
| | - Varun Sriram
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, United States
| | - Shannon Y. Wu
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, United States
| | - Dave Huang
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Alexis Cheney
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, United States
| | - Melodie F. Metzger
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Oskar Sundberg
- Department of Chemistry, University of Southern California, Los Angeles, CA, United States
| | - Karen M. Lyons
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, United States
- Department of Molecular, Cellular, and Developmental Biology, University of California at Los Angeles, Los Angeles, CA, United States
| | - Charles E. McKenna
- Department of Chemistry, University of Southern California, Los Angeles, CA, United States
| | - Ichiro Nishimura
- Weintraub Center for Reconstructive Biotechnology, School of Dentistry, University of California at Los Angeles, Los Angeles, CA, United States
| | - Thomas J. Kremen
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, United States
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Bedi A, Bishop J, Keener J, Lansdown DA, Levy O, MacDonald P, Maffulli N, Oh JH, Sabesan VJ, Sanchez-Sotelo J, Williams RJ, Feeley BT. Rotator cuff tears. Nat Rev Dis Primers 2024; 10:8. [PMID: 38332156 DOI: 10.1038/s41572-024-00492-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
Rotator cuff tears are the most common upper extremity condition seen by primary care and orthopaedic surgeons, with a spectrum ranging from tendinopathy to full-thickness tears with arthritic change. Some tears are traumatic, but most rotator cuff problems are degenerative. Not all tears are symptomatic and not all progress, and many patients in whom tears become more extensive do not experience symptom worsening. Hence, a standard algorithm for managing patients is challenging. The pathophysiology of rotator cuff tears is complex and encompasses an interplay between the tendon, bone and muscle. Rotator cuff tears begin as degenerative changes within the tendon, with matrix disorganization and inflammatory changes. Subsequently, tears progress to partial-thickness and then full-thickness tears. Muscle quality, as evidenced by the overall size of the muscle and intramuscular fatty infiltration, also influences symptoms, tear progression and the outcomes of surgery. Treatment depends primarily on symptoms, with non-operative management sufficient for most patients with rotator cuff problems. Modern arthroscopic repair techniques have improved recovery, but outcomes are still limited by a lack of understanding of how to improve tendon to bone healing in many patients.
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Affiliation(s)
- Asheesh Bedi
- Department of Orthopedic Surgery, University of Chicago, Chicago, IL, USA
- NorthShore Health System, Chicago, IL, USA
| | - Julie Bishop
- Department of Orthopedic Surgery, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Jay Keener
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Drew A Lansdown
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Peter MacDonald
- Department of Surgery, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Vani J Sabesan
- HCA Florida JFK Orthopaedic Surgery Residency Program, Atlantis Orthopedics, Atlantis, FL, USA
| | | | - Riley J Williams
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Brian T Feeley
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA.
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Alaia MJ, Li ZI, Chalem I, Hurley ET, Vasavada K, Gonzalez-Lomas G, Rokito AS, Jazrawi LM, Kaplan K. Cannabidiol for Postoperative Pain Control After Arthroscopic Rotator Cuff Repair Demonstrates No Deficits in Patient-Reported Outcomes Versus Placebo: 1-Year Follow-up of a Randomized Controlled Trial. Orthop J Sports Med 2024; 12:23259671231222265. [PMID: 38322981 PMCID: PMC10846110 DOI: 10.1177/23259671231222265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/10/2023] [Indexed: 02/08/2024] Open
Abstract
Background Cannabidiol (CBD) has been shown recently to positively affect patient pain and satisfaction immediately after arthroscopic rotator cuff repair (ARCR). However, it is unclear whether the addition of CBD to a perioperative regimen could affect postoperative outcomes. Purpose To evaluate patient-reported outcomes among patients who underwent ARCR and received buccally absorbed CBD or an identical placebo for early postoperative pain management at 1-year follow-up. Study Design Randomized controlled trial; Level of evidence, 2. Methods Eligible patients had previously participated in a multicenter, placebo-controlled, randomized, double-blinded trial that evaluated the analgesic effects of CBD in the immediate postoperative period after ARCR. The experimental group received 25 mg of CBD 3 times/day if <80 kg and 50 mg of CBD 3 times/day if >80 kg for 14 days, with the control group receiving an identical placebo. The following outcomes were assessed at minimum 1-year follow-up: visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and patient satisfaction. The rates of achievement of the Patient Acceptable Symptom State (PASS) were compared based on ASES at latest follow-up. Continuous and categorical variables were compared with the Mann-Whitney U test and Fisher exact test, respectively. Results Follow-up was obtained from 83 of 99 patients (83.8%) who completed the original trial. There were no significant differences between the CBD and control groups with respect to age, sex, body mass index, rate of concomitant procedures, or number of anchors used intraoperatively. At 1-year follow-up, there were no significant differences between the CBD and control groups in VAS pain (0.8 vs 1.2, P = .38), ASES (93.0 vs 91.1, P = .71), SANE (87.6 vs 90.1, P = .24), or satisfaction (97.4 vs 95.4, P = .41). A majority of patients achieved the PASS (81.0% [CBD] vs 77.5% [control]; P = .79). Conclusion Perioperative use of CBD for pain control among patients undergoing ARCR did not result in any significant deficits in pain, satisfaction, or patient-reported outcomes at 1-year postoperatively compared with a placebo control group. These findings suggest that CBD can be considered in a postoperative multimodal pain management regimen without detrimental effects on outcome. Registration NCT04672252 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Michael J. Alaia
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Zachary I. Li
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Isabel Chalem
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Eoghan T. Hurley
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Kinjal Vasavada
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Guillem Gonzalez-Lomas
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Andrew S. Rokito
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Laith M. Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Kevin Kaplan
- Department of Orthopedic Surgery, Jacksonville Orthopaedic Institute, Jacksonville, Florida, USA
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Weiss-Laxer NS, Pavlesen S, Arevalo A, Jeffords J, Haider MN, Bisson LJ. Predictors of Postoperative Patient-Reported Outcome Measure Response Rates Among Patients With Rotator Cuff Repair. Am J Sports Med 2024; 52:215-223. [PMID: 38164664 DOI: 10.1177/03635465231209441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) contribute to evaluating and improving the quality of patient care. Patient outcomes after rotator cuff repair (RCR) have been researched; however, the relationship between PROM response rates and individual and health care correlates has not been thoroughly investigated. PURPOSE To examine differences in individual and health care factors among patients who had undergone RCR based on their PROM response rates. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Shoulder-specific and general PROMs were solicited via email and text message of all patients who underwent RCR between 2016 and 2020. Three subgroups were classified: (1) complete responders completed all 1-year postoperative PROMs, (2) partial responders answered enough questions to produce ≥1 usable score, and (3) nonresponders did not respond to a single measure. Correlates were assessed using analysis of variance and chi-square tests. Adjusted multinomial logistic regression models identified predictors of 1-year PROM response. RESULTS Of 2195 patients included at the 1-year follow-up, 34% were complete responders; 11%, partial responders; and 55%, nonresponders. Patients had a mean age of 61.8 years, 63% were men, and 90% were White. Pre- and postoperative PROM scores were similar across responder groups. In stepwise selection, 1-year responses (complete or partial) were associated with older age, later year of surgery, White race, and having workers' compensation insurance. The strongest predictor of PROM response was having workers' compensation insurance. CONCLUSION Patients with workers' compensation insurance compared with other insurance types responded to PROMs at disproportionately higher rates. This could distort postoperative PROM scores in the population studied because there are known differences among patients with this insurance status.
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Affiliation(s)
- Nomi S Weiss-Laxer
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Sonja Pavlesen
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Alfonso Arevalo
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Joycelyn Jeffords
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Mohammad N Haider
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Leslie J Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
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Cerri-Droz PE, Ling K, Aknoukh S, Komatsu DE, Wang ED. Diabetes mellitus as a risk factor for postoperative complications following arthroscopic rotator cuff repair. JSES Int 2023; 7:2361-2366. [PMID: 37969508 PMCID: PMC10638576 DOI: 10.1016/j.jseint.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background Patients with diabetes mellitus who undergo arthroscopic rotator cuff repair (aRCR) have an increased risk of postoperative complications when compared to nondiabetics. To further investigate these complications, we used a large national database to determine the 30-day postoperative complications associated with insulin-dependent and non-insulin-dependent diabetics following aRCR. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for all patients who underwent aRCR between 2015 and 2020. The study population was categorized into cohorts based on diabetes mellitus status: non-insulin-dependent diabetes mellitus (NIDDM), insulin-dependent diabetes mellitus (IDDM), and no diabetes. Multivariate analysis, adjusted for confounding demographics and comorbidities, was used to determine independently associated complications. Results There were 39,877 cases of aRCR in NQSIP included in this study. Diabetics comprised 6575 (16.7%) of these cases, with 4758 being NIDDM (11.9%) and 1817 being IDDM (4.6%). Bivariate logistic regression found both NIDDM and IDDM cohorts to be significantly associated with higher body mass index, ASA class ≥3, hypertension, chronic obstructive pulmonary disease, bleeding disorders, and preoperative wounds or infection (P < .001). NIDDM was an independently associated risk factor for sepsis (odds ratio [OR], 2.77; 95% confidence interval [CI]: 1.01-7.58; P = .047). IDDM was an independently associated risk factor for pneumonia (OR, 2.49; 95% CI: 1.13-5.48; P = .023), readmission (OR, 1.617; 95% CI: 1.19-2.33; P = .003), myocardial infarction (OR, 0.50; 95% CI: 0.12-1.00; P = .048), and on a ventilator >48 hours (OR, 5.63; 95% CI: 1.40-22.62; P = .015). Conclusion NIDDM is an independent risk factor for sepsis, while IDDM is an independent risk factor for pneumonia, readmission, myocardial infarction, and remaining on a ventilator for greater than 48 hours following aRCR.
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Affiliation(s)
| | - Kenny Ling
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Samuel Aknoukh
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - David E. Komatsu
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Edward D. Wang
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
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Sherman NC, Haddad DJ, Bridge NW, Feldman MD. Orthopedic surgery residents reported increased shoulder procedure volumes during the COVID-19 pandemic. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:524-528. [PMID: 37928993 PMCID: PMC10624997 DOI: 10.1016/j.xrrt.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background The purpose of this study is to evaluate the impact of the COVID-19 pandemic on shoulder procedure volumes reported to the Accreditation Council for Graduate Medical Education by orthopedic surgery residents. Methods We performed a retrospective review of Accreditation Council for Graduate Medical Education case logs reporting data from graduating orthopedic surgery residents during the academic years of 2006-2022. Data were queried for all patients for the following shoulder Current Procedural Terminology codes: incision, excision, intro or removal, repair/revision/reconstruction, fracture and/or dislocation, manipulation, arthroscopy, trauma, and total procedures performed. Individual t-tests were used to compare case log trends of graduating academic years before (classes of 2018 and 2019) and during (classes of 2020, 2021, and 2022) the COVID-19 pandemic. Statistical significance was established to be P <.05 for total procedure types, but at P <.005 during category comparisons to protect against alpha errors. Results Reported mean total shoulder procedures per resident steadily increased each year from 2017 to 2022, but the only significant increase was seen when comparing the graduating classes of 2020 to 2021 (157.9 vs. 165.7, P =.02). Stratification of these procedures by subgroup revealed a significant increase in manipulation procedures from 2021 to 2022 (7.3 vs. 8.8, P =.001). Discussion/Conclusion COVID-19 did not have a negative impact on logged shoulder procedure volume. Orthopedic surgery residents graduating during the COVID-19 pandemic reported more shoulder procedures than those graduating prepandemic. However, shoulder procedure log trends should be longitudinally investigated, as preceding years of procedural opportunities may underestimate the pandemic's impact.
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Affiliation(s)
- Nathan C. Sherman
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - David J. Haddad
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - Nathaniel W. Bridge
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX, USA
| | - Michael D. Feldman
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
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Gulbrandsen MT, O’Reilly OC, Gao B, Cannon D, Jesurajan J, Gulbrandsen TR, Phipatanakul WP. Health literacy in rotator cuff repair: a quantitative assessment of the understandability of online patient education material. JSES Int 2023; 7:2344-2348. [PMID: 37969518 PMCID: PMC10638567 DOI: 10.1016/j.jseint.2023.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background The American Medical Association and National Institutes of Health recommend online health information be written at a 6th grade or lower reading level for clear understanding. While syntax reading grade level has previously been utilized, those analyses do not determine whether readers are processing key information (understandability) or identifying available actions to take (actionability). The Patient Education Materials Assessment Tool (PEMAT-P) is a method to measure the understandability and actionability of online patient education materials. The purpose of this study was to evaluate online resources regarding rotator cuff repair utilizing measures of readability, understandability, and actionability. Methods The search term "rotator cuff surgery" was used in two independent online searches to obtain the top 50 search results. The readability of included resources was quantified using valid objective algorithms: Flesch-Kincaid Grade-Level, Simple Measure of Gobbledygook grade, Coleman-Liau Index, and Gunning Fog Index. The PEMAT-P form was used to assess actionability and understandability. Results A total of 49 unique websites were identified to meet our inclusion criteria and were included in our analysis. The mean Flesch-Kincaid Grade Level graded materials at a 10.6 (approximately a 10th grade reading level), with only two websites offering materials at a 6th grade reading level or below. The remaining readability studies graded the mean reading level at high school or greater, with the Gunning Fog Index scoring at a collegiate reading level. Mean understandability and actionability scores were 64.6% and 29.5%, respectively, falling below the 70% PEMAT score threshold for both scales. Fourteen (28.6%) websites were above the threshold for understandability, while no website (0%) scored above the 70% threshold for actionability. When comparing source categories, commercial health publishers provided websites that scored higher in understandability (P < .05), while private practice materials scored higher in actionability (P < .05). Resources published by academic institutions or organizations scored lower in both understandability and actionability than private practice and commercial health publishers (P < .05). No readability, understandability, or actionability score was significantly associated with search result rank. Conclusion Overall, online patient education materials related to rotator cuff surgery scored poorly with respect to readability, understandability, and actionability. Only two (4.1%) of the patient education websites scored at the American Medical Association and National Institutes of Health recommended reading level. Fourteen (28.6%) scored above the 70% PEMAT score for understandability; however, no website met the threshold for actionability.
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Affiliation(s)
- Matthew T. Gulbrandsen
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Olivia C. O’Reilly
- Department of Orthopedic Surgery, University of Iowa Hospital, Iowa City, IA, USA
| | - Burke Gao
- Department of Orthopedic Surgery, University of Iowa Hospital, Iowa City, IA, USA
| | - Damion Cannon
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Jose Jesurajan
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | - Wesley P. Phipatanakul
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
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Mercier MR, Ratnasamy PP, Yee NS, Hall B, Del Baso C, Athar M, Daniels TR, Halai MM. Differential Utilization Patterns of Total Ankle Arthroplasty vs Arthrodesis: A United States National Ambulatory Database Analysis. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231218011. [PMID: 38145273 PMCID: PMC10748701 DOI: 10.1177/24730114231218011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
Abstract
Background End-stage ankle osteoarthritis is a condition that can be treated with ankle arthrodesis (AA) or total ankle arthroplasty (TAA). The goal of this study is to estimate the 2016-2017 United States' utilization of TAA and AA in specific ambulatory settings and delineate patient and hospital factors associated with the selection of TAA vs AA for treatment of ankle osteoarthritis. Methods TAA and AA procedures performed for ankle osteoarthritis were identified in the 2016-2017 Nationwide Ambulatory Surgery Sample (NASS) Database. Notably, the NASS database only examines instances of ambulatory surgery encounters at hospital-owned facilities. As such, instances of TAA and AA performed at privately owned or freestanding ambulatory surgical centers or those performed inpatient are excluded from this analysis. Cases were weighted using nationally representative discharge weights. Univariate analyses and a combined multiple logistic regression model were used to compare demographic, hospital-related, and socioeconomic factors associated with TAA vs AA. Results In total, 6577 cases were identified, which represents 9072 cases after weighting. Of these, TAA was performed for 2233 (24.6%). Based on the logistic regression model, several factors were associated with increased utilization of TAA vs AA. With regard to patient factors, older patients were more likely to undergo TAA, as well as females. Conversely, patients with a higher comorbidity burden were less likely to receive TAA over AA.With regard to socioeconomic factors, urban teaching and urban nonteaching hospitals were significantly more likely to use TAA compared to rural hospitals. Similarly, privately insured patients and those with a median household income of $71 000 or more were also more likely to receive TAA over AA. Private hospitals ("not-for-profit" and "investor-owned") were significantly more likely to offer TAA over AA. Conclusion Using a large nationally representative cohort, the current data revealed that during 2016-2017, 24.6% of operatively treated cases of end-stage ankle osteoarthritis in the ambulatory setting are treated with TAA. Associations between socioeconomic and hospital-level factors with TAA utilization suggest that nonclinical factors may influence surgical treatment choice for ankle osteoarthritis. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Michael R. Mercier
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Philip P. Ratnasamy
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Nicholas S. Yee
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Brandon Hall
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Christopher Del Baso
- Victoria Hospital, Division of Orthopaedic Surgery, University of Western Ontario, London, ON, Canada
| | - Mohammed Athar
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
- St. Michael’s Hospital, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Timothy R. Daniels
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
- St. Michael’s Hospital, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Mansur M. Halai
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
- St. Michael’s Hospital, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
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11
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Fassler R, Ling K, Tantone R, Komatsu DE, Wang ED. Chronic steroid use as a risk factor for postoperative complications following arthroscopic rotator cuff repair. JSES Int 2023; 7:780-785. [PMID: 37719824 PMCID: PMC10499866 DOI: 10.1016/j.jseint.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background Steroids are a common treatment for many rheumatologic and inflammatory disorders. Chronic steroid use has been studied in joint arthroplasty and arthroscopy, but studies specifically on preoperative chronic steroid use in arthroscopic rotator cuff repair (aRCR) are limited. The purpose of this study is to determine the association between chronic steroid use and 30-day postoperative outcomes following aRCR. Methods The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was queried to identify all patients who underwent aRCR between 2015 and 2020. Patients were divided into 2 cohorts: nonsteroid users and chronic steroid users. Univariate binomial regression analysis was used to compare demographics, comorbidities, and postoperative outcomes between cohorts. Multivariate regression analysis, adjusted for all significant demographics and comorbidities, was used to identify significant 30-day postoperative outcomes. Results A total of 39,876 patients remained after exclusion criteria, with 39,068 (97.97%) in the nonsteroid group and 808 (2.02%) in the chronic steroid group. Patient demographics and comorbidities significantly associated with chronic steroid use were age ≥65 (P < .001), female gender (P < .001), body mass index (BMI) ≥35, American Society of Anesthesiologists (ASA) ≥3 (P < .001), dependent functional status (P < .001), nonsmokers (P = .046), higher rates of dyspnea (P < .001), chronic obstructive pulmonary disease (COPD) (P < .001), congestive heart failure (P < .001), hypertension requiring medication (P < .001), open wound infection (P = .018), unintentional weight loss (P < .001), bleeding disorders (P < .001), and inpatient procedure (P = .013). Multivariate analysis found preoperative chronic steroid use to be an independent predictor of mortality within 30 days following aRCR (OR 8.15, confidence interval (CI) 1.45-45.86; P = .017). Conclusion Chronic steroid use was not found to be an independent risk factor for infection, readmission, or reoperation following aRCR. It was, however, found to be independently associated with higher rates of 30-day mortality following aRCR, although with a limited overall number of deaths reported.
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Affiliation(s)
- Richelle Fassler
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Kenny Ling
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Ryan Tantone
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - David E. Komatsu
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - Edward D. Wang
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
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12
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Pak SS, Janela D, Freitas N, Costa F, Moulder R, Molinos M, Areias AC, Bento V, Cohen SP, Yanamadala V, Souza RB, Correia FD. Comparing Digital to Conventional Physical Therapy for Chronic Shoulder Pain: Randomized Controlled Trial. J Med Internet Res 2023; 25:e49236. [PMID: 37490337 PMCID: PMC10474513 DOI: 10.2196/49236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/27/2023] [Accepted: 07/25/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Chronic shoulder pain (CSP) is a common condition with various etiologies, including rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis. It is associated with substantial disability and psychological distress, resulting in poor productivity and quality of life. Physical therapy constitutes the mainstay treatment for CSP, but several barriers exist in accessing care. In recent years, telerehabilitation has gained momentum as a potential solution to overcome such barriers. It has shown numerous benefits, including improving access and convenience, promoting patient adherence, and reducing costs. However, to date, no previous randomized controlled trial has compared fully remote digital physical therapy to in-person rehabilitation for nonoperative CSP. OBJECTIVE The aim of this study is to compare clinical outcomes between digital physical therapy and conventional in-person physical therapy in patients with CSP. METHODS We conducted a single-center, parallel-group, randomized controlled trial involving 82 patients with CSP referred for outpatient physical therapy. Participants were randomized into digital or conventional physical therapy (8-week interventions). The digital intervention consisted of home exercise, education, and cognitive behavioral therapy (CBT), using a device with movement digitalization for biofeedback and asynchronous physical therapist monitoring through a cloud-based portal. The conventional group received in-person physical therapy, including exercises, manual therapy, education, and CBT. The primary outcome was the change (baseline to 8 weeks) in function and symptoms using the short-form of Disabilities of the Arm, Shoulder, and Hand questionnaire. Secondary outcome measures included self-reported pain, surgery intent, analgesic intake, mental health, engagement, and satisfaction. All questionnaires were delivered electronically. RESULTS A total of 90 participants were randomized into digital or conventional physical therapy, with 82 receiving the allocated intervention. Both groups experienced significant improvements in function measured by the short-form of the Disabilities of the Arm, Shoulder, and Hand questionnaire, with no differences between groups (-1.8, 95% CI -13.5 to 9.8; P=.75). For secondary outcomes, no differences were observed in surgery intent, analgesic intake, and mental health or worst pain. Higher reductions were observed in average and least pain in the conventional group, which, given the small effect sizes (least pain 0.15 and average pain 0.16), are unlikely to be clinically meaningful. High adherence and satisfaction were observed in both groups, with no adverse events. CONCLUSIONS This study shows that fully remote digital programs can be viable care delivery models for CSP given their scalability and effectiveness, assessed through comparison with high-dosage in-person rehabilitation. TRIAL REGISTRATION ClinicalTrials.gov (NCT04636528); https://clinicaltrials.gov/study/NCT04636528.
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Affiliation(s)
- Sang S Pak
- Department of Physical Therapy and Rehabilitation, University of California San Francisco, San Francisco, CA, United States
| | | | - Nina Freitas
- Department of Physical Therapy and Rehabilitation, University of California San Francisco, San Francisco, CA, United States
| | | | - Robert Moulder
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, United States
| | | | | | | | - Steven P Cohen
- Department of Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | | | - Richard B Souza
- Department of Physical Therapy and Rehabilitation, University of California San Francisco, San Francisco, CA, United States
| | - Fernando Dias Correia
- Sword Health Inc, Draper, UT, United States
- Department of Neurology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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13
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Brush PL, Santana A, Nanavati R, Toci GR, Issa TZ, Fletcher DJ, Hornstein J. Arthroscopic Treatment of Shoulder Stiffness With Rotator Cuff Repair Yields Similar Outcomes to Isolated Rotator Cuff Repair. Arthrosc Sports Med Rehabil 2023; 5:100751. [PMID: 37577173 PMCID: PMC10413075 DOI: 10.1016/j.asmr.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/25/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose To compare patient-reported and surgical outcome measures in patients with and without secondary shoulder stiffness (SSS) undergoing rotator cuff repair (RCR). Methods Patients undergoing rotator cuff repair from 2014 to 2020 with complete patient-reported outcome measures (PROMs) by the short-form 12 survey (SF-12) were retrospectively reviewed to identify if operative intervention for SSS was performed alongside the RCR. Those patients with operative intervention for SSS were propensity matched to a group without prior intervention for stiffness by age, sex, laterality, body mass index, diabetes mellitus status, and the presence of a thyroid disorder. The groups were compared by rotator cuff tear (RCT) size, surgical outcomes, further surgical intervention, rotator cuff retear rate, postoperative range of motion (ROM), and SF-12 results at 1 year after surgery. Delta values were calculated for component scores of the SF-12 and ROM values by subtracting the preoperative result from the postoperative result. Results A total of 89 patients with SSS were compared to 156 patients in the control group at final analysis. The patients in the SSS group experienced a significant improvement in the delta mental health component score (MCS-12) of the SF-12 survey that was not seen in the control group (P = .005 to P = .539). Both groups experienced significant improvement by the delta physical health component score (PCS-12) of the SF-12 survey (SSS: 7.68; P < .001; control: 6.95; P < .001). The SSS group also experienced greater improvement of their forward flexion (25.8° vs 12.9°; P = .005) and external rotation (7.13° vs 1.65°; P = .031) ROM than the control group. Conclusions Operative intervention of SSS at the time of RCR has equivalent postoperative SF-12 survey outcome scores when compared to patients undergoing RCR without preoperative stiffness despite those patients having lower preoperative scores. Level of Evidence Level III retrospective comparative study.
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Affiliation(s)
- Parker L. Brush
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Adrian Santana
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - Ruchir Nanavati
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
| | - Gregory R. Toci
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Tariq Z. Issa
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Daniel J. Fletcher
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Joshua Hornstein
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
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14
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Crabtree RM, Field LD. Medialized Rip-Stop Convergence Technique for Retracted Rotator Cuff Tears. Arthrosc Tech 2023; 12:e1429-e1436. [PMID: 37654889 PMCID: PMC10466296 DOI: 10.1016/j.eats.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 09/02/2023] Open
Abstract
Attempts to restore the anatomical footprint during rotator cuff repair for retracted, relatively immobile tears can be difficult. In some cases, it can lead to excessive tension of the repair. Previous studies have noted improved clinical outcomes when repair tension is not excessive, and medialization of the anatomical footprint has been suggested as a technique that can help surgeons repair large, retracted tears without excessive tension and achieve improved clinical outcomes. Of note, excessive tension when restoring the rotator cuff tendon to the anatomical footprint is not limited to large, retracted tears. In some cases, restoring small- and medium-sized tears to the anatomical footprint also can lead to excessive tension. Therefore, it is not uncommon for the authors to employ some degree of footprint medialization even for repair of small- or medium-sized tears if repair to the anatomical footprint will lead to excess tension. The purpose of this article and video demonstration is to provide instruction for a reproducible rotator cuff technique using a medialized single-row rip-stop construct combined with convergence.
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Affiliation(s)
- Reaves M. Crabtree
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A
| | - Larry D. Field
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A
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15
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Ahiarakwe U, Agarwal AR, Chi-Ya Y, Pearson ZC, Weisberg M, Srikumaran U, Best MJ. The Persistent Backlog of Knee and Shoulder Orthopedic Sport Surgery Case Volume Following the COVID-19 Pandemic. THE ARCHIVES OF BONE AND JOINT SURGERY 2023; 11:738-751. [PMID: 38146523 PMCID: PMC10748816 DOI: 10.22038/abjs.2023.71724.3348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/28/2023] [Indexed: 12/27/2023]
Abstract
Objectives As COVID-19 will not be the last pandemic, understanding our historical response allows us to predict and improve our current practices in preparation for the next pandemic. Following the removal of the elective surgery suspension at the onset of the COVID-19 pandemic, it is unclear whether sports medicine surgery volume has returned to pre-pandemic levels as well as whether the backlog from the original suspension was addressed. The purpose of this study to observe the monthly changes in volume and backlog of knee and shoulder sports surgery one year since the original suspension. Methods National all-payer data was utilized to identify patients undergoing knee and shoulder sports procedures from January 2017 to April 2021. Descriptive analysis was utilized to report the monthly changes in surgeries. A linear forecast analysis using historical data was utilized to determine the expected volume. This was compared to the observed case volume. The difference in expected and observed volume was utilized to calculate the estimated change in backlog. Results From March to May 2020, there was a persistent decrease in the observed shoulder and knee sports volume when compared to the expected volume. By June 2020, all knee and shoulder sports volume reached the expected volume. By April 2021, the estimated backlog for shoulder and knee procedures had increased by 49.8% (26,412 total cases) and 19.0% (26,412 total cases), respectively, with respect to the original calculated backlog from March to May 2020. Conclusion Within four months, the sudden decrease in volume for knee and shoulder sports procedures had returned to pre-pandemic levels; however, the original backlog in cases has continually increased one year following the suspension. Additionally, the backlog is significantly higher for knee when compared to shoulder surgeries.
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Affiliation(s)
- Uzoma Ahiarakwe
- Johns Hopkins University School of Medicine, Department of Orthopaedic Surgery, Columbia
| | - Amil R. Agarwal
- Johns Hopkins University School of Medicine, Department of Orthopaedic Surgery, Columbia
| | - Yang Chi-Ya
- Johns Hopkins University School of Medicine, Department of Orthopaedic Surgery, Columbia
| | - Zachary C. Pearson
- Johns Hopkins University School of Medicine, Department of Orthopaedic Surgery, Columbia
| | - Miriam Weisberg
- Johns Hopkins University School of Medicine, Department of Orthopaedic Surgery, Columbia
| | - Uma Srikumaran
- Johns Hopkins University School of Medicine, Department of Orthopaedic Surgery, Columbia
| | - Matthew J. Best
- Johns Hopkins University School of Medicine, Department of Orthopaedic Surgery, Columbia
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16
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Raso J, Althoff A, Brunette C, Kamalapathy P, Arney M, Werner BC. Preoperative Substance Use Disorder Is Associated With an Increase in 90-Day Postoperative Complications, 1-Year Revisions and Conversion to Arthroplasty Following Arthroscopic Rotator Cuff Repair: Substance Use Disorder on the Rise. Arthroscopy 2022; 39:1386-1393.e4. [PMID: 36586469 DOI: 10.1016/j.arthro.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/03/2022] [Accepted: 12/13/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of the current study was to use a nationwide administrative-claims database to characterize the substance use disorder trends of patients undergoing arthroscopic rotator cuff repair (RCR). Additionally, we sought to evaluate the influence of preoperative substance use disorder on postoperative outcomes following arthroscopic RCR. METHODS The Mariner database was used to identify patients undergoing RCR using CPT codes, ages 18-84 years old, from 2010 to 2019. Patients were stratified by substance use, including cannabis, cocaine, nicotine, alcohol, opioids, stimulants, or sedative, as defined by International Classification of Diseases (ICD) codes. Substance use disorders trends were reported. Postoperative outcomes assessed consisted of major complications, minor complications, infections, readmissions, and Emergency Department visits within 90 days of surgery. Additionally, postoperative stiffness, revision surgery, and conversion to arthroplasty within 1 year were evaluated. Multivariate logistic regressions were used to control for demographic and comorbid factors. RESULTS Substance use trends from 2010 to 2019 show an increase in documentation of substance use in patients undergoing RCR. Individuals with a history of substance use disorder had an increased risk of adverse outcomes, most notably major medical complications (odds ratio [OR]: 1.63; 95% confidence interval [CI]: 1.44-1.86; P < .001), revision surgery (OR: 1.43; 95% CI: 1.30-1.56; P < .001), and conversion to arthroplasty (OR: 1.40; 95% CI: 1.08-1.80; P = .009). Subgroup analysis demonstrated that cannabis users were at higher risk for major medical complications (OR: 1.75; 95% CI: 1.15-2.56; P < .001), conversion to arthroplasty (OR: 3.54; 95% CI: 1.77-6.4; P < .001), and revision (OR: 1.53; 95% CI: 1.12-2.04; P < .05) compared to controls. Additionally, substance use was associated with higher medical costs in terms of procedural cost (β; $3634: $3,490-3,777) and 90-day postoperative costs (β: $436; $375-$498). CONCLUSION Documentation of substance use disorder is increasing in individuals undergoing arthroscopic rotator cuff repair. Substance use is associated with higher rates of postoperative complications, overall costs, and revision surgery following arthroscopic RCR. Nicotine and cannabis use were most commonly associated with increased rates of postoperative complications and treatment failure. LEVEL OF EVIDENCE IV, retrospective therapeutic case series.
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Affiliation(s)
- Jon Raso
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Alyssa Althoff
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Colby Brunette
- University of Virginia, School of Medicine, Charlottesville, Virginia, U.S.A
| | - Pramod Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Monica Arney
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
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