Costs, Complications, and Reoperations Associated With Primary Arthroscopic Rotator Cuff Repair With or Without Acromioplasty and/or Biceps Tenodesis

Abstract

To evaluate the reoperations, complications, and costs up to 5 years following arthroscopic rotator cuff repair (RCR) alone, with acromioplasty (acro), with biceps tenodesis (BT), or with both acro and BT. Methods: We queried the MarketScan database to identify patients who underwent RCR from 2007 to 2016. Patients were stratified into groups based on concomitant procedures (acro and/or BT) performed on the same day as index RCR. Reoperations, complications, and costs were followed for 5 years post-index procedure. Patients without laterality codes were excluded. A multivariate logistic regression analysis was used to control for confounding factors. Results: This study identified 147,838 patients (mean age, 53.1 years; standard deviation, 8.3 years) who underwent primary RCR. Patients were stratified into 4 groups: (1) RCR only, (2) RCR þ acro, (3) RCR þ BT, and (4) RCR þ acro þ BT. Patients in the RCR only group experienced the highest rate of unadjusted overall postoperative complications (17.2%) versus the other groups (RCR þ acro 16.4%, RCR þ BT 15.1%, RCR þ acro þ BT 16.2%, P < .0161). The RCR only group also experienced a significantly greater number of reoperations on the ipsilateral shoulder (P < .0001), whereas the RCR þ acro þ BT had the highest costs at all timepoints. In the regression analysis, there was no significant differences between complications and reoperations between any groups. After adjusting for covariates, the performance of a BT with an RCR and acromioplasty led to increased costs (odds ratio, 1.47, 1.37-1.59, P < .001). Conclusions: Concomitant biceps tenodesis does lead to higher total healthcare costs, both in the shorter and longer terms. When adjusting for confounding factors, the performance of concomitant biceps tenodesis with rotator cuff repair does not lead to a difference in postoperative complication rate or risk for revision surgery. Level of Evidence: Level IV, economic analysis.

The impact of external beam radiation therapy on shoulder surgical outcomes: a case series study

“…Compared to average complication rates from national registry data, we observed an increased rate of postoperative complications in our XRT-specific cohort (RCR 10.3%-17.2% 28,30 vs. 40%, arthroplasty 4%-14.2% 3,12 vs. 28.6%). Available data on the effects of XRT on shoulder surgical outcomes are overall lacking.…”

Influential factors of subacromial impingement syndrome after hook plate fixation for acromioclavicular joint dislocation

“…Flatow et al suggested that the normal AHI should be greater than 1 cm. [ 21 ] If it was less than 1 cm, it was considered a stenosis and the greater tubercles of the humerus would hit the acromion. [ 22 ] Some scholars believed that when AHI > 10.6 mm, the use of clavicular hook plate fixation generally did not cause SIS.…”

“…The measurement and evaluation of the subacromial space of the patient was commonly referred to as acromion humeral interval (AHI). Flatow et al suggested that the normal AHI should be greater than 1 cm [21] . If it was less than 1 cm, it was considered a stenosis and the greater tubercles of the humerus would hit the acromion [22] .…”

The Effect of Concomitant Biceps Tenodesis on Revision Surgery Rates After Primary Rotator Cuff Repair

“…9 Reported disadvantages of tenodesis include higher healthcare costs and a lack of consensus on the ideal surgical technique. [10][11][12][13] In addition, although rare (,1%), complications specific to tenodesis have been reported including loss of fixation, infection, hematoma, and complex regional pain syndrome. 13 The incidence of subsequent procedures after isolated rotator cuff repair (RCR) remains high.…”