Risk Factors for Short-Term Complications After Rotator Cuff Repair in the United States

Authors

William W. Schairer, MD, Benedict U. Nwachukwu, MD, MBA, Michael C. Fu, MD, Russell F. Warren, MD

Journal

Arthroscopy: The Journal of Arthroscopic and Related Surgery, 2018-04-01, Volume 34, Issue 4, Pages 1158-1163.

Abstract

Purpose

To use a population-level dataset to evaluate the rate of 30-day complications after rotator cuff repair, and to evaluate the risk factors for complication and unplanned hospital readmission.

Methods

We used the American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2015 to identify patients who underwent rotator cuff repair and concomitant procedures using Current Procedural Terminology codes. Postoperative complications and unplanned hospital readmissions were identified. Patient demographics, medical comorbidities, and perioperative variables were used in a multivariate logistic regression model to identify the risk factors for infection, any complication, and unplanned hospital readmission.

Results

A total of 23,741 patients were identified who underwent rotator cuff repair. Overall, 1.39% of patients experienced at least 1 complication, with 0.66% minor complications and 0.85% major complications. Unplanned readmission occurred in 1.16% of patients. Infection was the most common complication, occurring in 0.3% of patients (n = 72), and was the most common reason for return to the operating room. Open rotator cuff repair and male gender were independent risk factors for all outcomes. Increased age and numerous medical comorbidities were associated with the risk of any complication or unplanned hospital readmission.

Conclusions

Rotator cuff repair has a low incidence of short-term complications. Infection was the most common complication. Open repair, male gender, increased age, and medical comorbidities all significantly increased the risk of complications and hospital readmission.

Level of Evidence

Level IV, case series.

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About the Author

Dr. Michael Fu is an orthopedic surgeon and shoulder specialist at the Hospital for Special Surgery (HSS) in New York City (NYC) and New Jersey (NJ), the best hospital for orthopedics as ranked by U.S. News & World Report. Dr. Fu is an expert at shoulder rotator cuff repair surgery, shoulder instability surgery, and shoulder replacement. Dr. Fu was educated at Columbia University and Yale School of Medicine, followed by orthopedic surgery residency at HSS and sports medicine & shoulder surgery fellowship at Rush University Medical Center in Chicago. He has been a team physician for the Chicago Bulls, Chicago White Sox, DePaul University, and NYC’s PSAL.

Disclaimer: All materials presented on this website are the opinions of Dr. Michael Fu and any guest writers, and should not be construed as medical advice. Each patient’s specific condition is different, and a comprehensive medical assessment requires a full medical history, physical exam, and review of diagnostic imaging. If you would like to seek the opinion of Dr. Michael Fu for your specific case, we recommend contacting our office to make an appointment.

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Epidemiology of Injuries in Tennis Players

Authors

Michael C. Fu, MD, MHS, Todd S. Ellenbecker, Per A. Renstrom, Gary S. Windler, David M. Dines, MD

Journal

Current Reviews in Musculoskeletal Medicine. 2018 Mar; 11(1): 1–5.

Abstract

Purpose of review

To review the recent literature regarding the epidemiology of tennis injuries at all levels of play, and to discuss recent findings in injury surveillance by the Association of Tennis Professionals (ATP).

Recent findings

Following the release of a consensus statement in 2009 calling for standardized documentation and analysis of tennis-related injuries, multiple studies have been published describing longitudinal injury incidences at Grand Slam tournaments and the Davis Cup. Recent efforts by the ATP have further elucidated injury patterns on tour. There have also been recent high-quality studies on injury trends among collegiate and elite junior tennis players, bringing attention to musculoskeletal injuries and systemic illnesses that young tennis players may be susceptible to.

Summary

Recent efforts in injury surveillance by the ATP and at the collegiate and junior levels have highlighted injury trends that will help guide injury prevention strategies at various levels of play.

Keywords: Tennis, Injury, Epidemiology, Professional tennis, Junior tennis, ATP

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About the Author

Dr. Michael Fu is an orthopedic surgeon and shoulder specialist at the Hospital for Special Surgery (HSS), the best hospital for orthopedics as ranked by U.S. News & World Report. Dr. Fu treats the entire spectrum of shoulder conditions, including rotator cuff tears, shoulder instability, and shoulder arthritis. Dr. Fu was educated at Columbia University and Yale School of Medicine, followed by orthopedic surgery residency at HSS and sports medicine & shoulder surgery fellowship at Rush University Medical Center in Chicago. He has been a team physician for the Chicago Bulls, Chicago White Sox, DePaul University, and NYC’s PSAL.

Disclaimer: All materials presented on this website are the opinions of Dr. Michael Fu and any guest writers, and should not be construed as medical advice. Each patient’s specific condition is different, and a comprehensive medical assessment requires a full medical history, physical exam, and review of diagnostic imaging. If you would like to seek the opinion of Dr. Michael Fu for your specific case, we recommend contacting our office to make an appointment.

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Increased Shoulder Arthroscopy Time Is Associated With Overnight Hospital Stay and Surgical Site Infection

Authors

Venkat Boddapati, BA, Michael C. Fu, MD, MHS, William W. Schairer, MD, Anil S. Ranawat, MD, David M. Dines, MD, Samuel A. Taylor, MD, Joshua S. Dines, MD

Journal

Arthroscopy: The Journal of Arthroscopic and Related Surgery, 2018-02-01, Volume 34, Issue 2, Pages 363-368

Abstract

Purpose

The purpose of this study was to characterize the rates of short-term postoperative complications, readmissions, and overnight hospital stays as a function of shoulder arthroscopy procedure time. A secondary aim of this current study was to identify baseline patient risk factors for adverse outcomes.

Methods

This study used the American College of Surgeons National Surgical Quality Improvement Program registry from 2012 to 2015. Shoulder arthroscopy cases were categorized based on operative time, either <45 minutes, between 45 and 90 minutes, or >90 minutes. The rates of 30-day postoperative complications, readmissions, and overnight hospital stays were compared with bivariate and multivariate analysis.

Results

In total, 33,095 shoulder arthroscopy procedures were identified. Of these, 7,027 (21.2%) were <45 minutes, 16,610 (50.2%) were between 45 and 90 minutes, and 9,458 (28.6%) were >90 minutes. Multivariate analysis identified increased the risk of superficial surgical site infections (SSIs) for procedures lasting between 45 and 90 minutes (odds ratio [OR] = 3.63; P = .036) and for procedures >90 minutes (OR = 4.40; P = .019), compared with procedures <45 minutes. Furthermore, there was an increased risk of overnight hospital stay for patients who had a shoulder arthroscopy lasting between 45 and 90 minutes (OR = 1.33) and >90 minutes (OR = 2.14), compared with procedures <45 minutes. A body mass index >30 kg/m 2 was an independent predictor of both overnight hospital stay and superficial SSI ( P = .020). Age >60, female gender, American Society of Anesthesiologists class ≥3, and a history of diabetes mellitus, hypertension, or chronic obstructive pulmonary disease were additional predictors of overnight hospital stay ( P < .001 for all comparisons, unless otherwise noted).

Conclusions

Increased shoulder arthroscopy procedure time is associated with adverse short-term outcomes, particularly superficial SSI and overnight hospital stay. This information may be useful for patient counseling and postoperative risk stratification, as operative time is an easily measured surrogate for surgical complexity or difficulty.

Level of Evidence

Retrospective cohort study, Level III.

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About the Author

Dr. Michael Fu is an orthopedic surgeon and shoulder specialist at the Hospital for Special Surgery (HSS), the best hospital for orthopedics as ranked by U.S. News & World Report. Dr. Fu treats the entire spectrum of shoulder conditions, including rotator cuff tears, shoulder instability, and shoulder arthritis. Dr. Fu was educated at Columbia University and Yale School of Medicine, followed by orthopedic surgery residency at HSS and sports medicine & shoulder surgery fellowship at Rush University Medical Center in Chicago. He has been a team physician for the Chicago Bulls, Chicago White Sox, DePaul University, and NYC’s PSAL.

Disclaimer: All materials presented on this website are the opinions of Dr. Michael Fu and any guest writers, and should not be construed as medical advice. Each patient’s specific condition is different, and a comprehensive medical assessment requires a full medical history, physical exam, and review of diagnostic imaging. If you would like to seek the opinion of Dr. Michael Fu for your specific case, we recommend contacting our office to make an appointment.

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Surgical Anatomy of the Radial Nerve in the Deltopectoral Approach for Revision Shoulder Arthroplasty and Periprosthetic Fracture Fixation: A Cadaveric Study

Authors

Michael C. Fu, MD, MHS, Michael D. Hendel, MD, PhD, Xiang Chen, MS, Russell F. Warren, MD, David M. Dines, MD, Lawrence V. Gulotta, MD

Journal

Journal of Shoulder and Elbow Surgery, 2017-12-01, Volume 26, Issue 12, Pages 2173-2176

Abstract

Background

Radial nerve injury is a rare but clinically significant complication of revision shoulder arthroplasty and fixation of native and periprosthetic proximal humeral fractures. Understanding of the anatomic relationship between the radial nerve as it enters the humeral spiral groove and anterior shoulder landmarks in a deltopectoral approach is necessary to avoid iatrogenic radial nerve injury.

Methods

Eight forequarter cadaveric specimens were dissected through a deltopectoral approach. Distances between the radial nerve entry into the proximal spiral groove and the coracoid process, distal lesser tuberosity/inferior subscapularis insertion, superior latissimus insertion, and inferior latissimus insertion were measured. Means, standard deviations, and ranges were determined for each distance.

Results

The radial nerve entry into the proximal spiral groove averaged 133.1 mm (range, 110.3-153.0 mm) from the coracoid process, 101.9 mm (range, 76.5-124.3 mm) from the distal lesser tuberosity/inferior subscapularis insertion, 81.0 mm (range, 63.4-101.5 mm) from the superior latissimus insertion, and 39.6 mm (range, 25.5-55.4 mm) from the inferior latissimus insertion. The proximal spiral groove was distal to the inferior latissimus insertion in all specimens.

Conclusion

The risk of iatrogenic injury to the radial nerve at the spiral groove may be minimized through proper identification and protection or avoidance of circumferential fixation. However, if encircling fixation with cerclage cables is necessary, instrumentation proximal to the inferior edge of the latissimus dorsi insertion may reduce the risk of radial nerve injury.

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About the Author

Dr. Michael Fu is an orthopedic surgeon and shoulder specialist at the Hospital for Special Surgery (HSS), the best hospital for orthopedics as ranked by U.S. News & World Report. Dr. Fu treats the entire spectrum of shoulder conditions, including rotator cuff tears, shoulder instability, and shoulder arthritis. Dr. Fu was educated at Columbia University and Yale School of Medicine, followed by orthopedic surgery residency at HSS and sports medicine & shoulder surgery fellowship at Rush University Medical Center in Chicago. He has been a team physician for the Chicago Bulls, Chicago White Sox, DePaul University, and NYC’s PSAL.

Disclaimer: All materials presented on this website are the opinions of Dr. Michael Fu and any guest writers, and should not be construed as medical advice. Each patient’s specific condition is different, and a comprehensive medical assessment requires a full medical history, physical exam, and review of diagnostic imaging. If you would like to seek the opinion of Dr. Michael Fu for your specific case, we recommend contacting our office to make an appointment.

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Effect of Metabolic Syndrome and Obesity on Complications After Shoulder Arthroplasty

Authors

Grant H. Garcia, MD, Michael C. Fu, MD, MHS, Matthew L. Webb, BA, David M. Dines, MD, Edward V. Craig, MD, MPH, Lawrence V. Gulotta, MD

Journal

Orthopedics. 2016;39(5):309-316

Abstract

Metabolic syndrome can adversely affect surgical outcomes. This study evaluated the postoperative outcomes of patients with metabolic syndrome after total shoulder arthroplasty (TSA). A retrospective cohort study of 4751 patients undergoing TSA was conducted with use of the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2013. Metabolic syndrome was defined as hypertension, diabetes, and body mass index of 30.0 kg/m2 or greater. Multivariable logistic regression analysis was performed for the outcomes of any postoperative complications and extended length of stay. Patients classified as obese III had a significantly increased risk of extended length of stay (P=.011) compared with control subjects who were of normal weight. In the multivariable adjusted models, compared with nonobese patients, those classified as obese I and obese II had a significantly decreased risk of postoperative complications (odds ratio, 0.84, P=.020, and odds ratio, 0.82, P=.045, respectively), whereas those classified as obese I were less likely to have extended length of stay (odds ratio, 0.79, P=.004). Metabolic syndrome was not a significant predictor of postoperative complications or extended length of stay. Morbidly obese patients undergoing TSA have an increased risk of postoperative complications and extended length of stay. Those classified as obese I and obese II may have a decreased risk of postoperative complications and shorter length of stay. Despite the hypothesized negative effect of metabolic syndrome on outcomes, the overall effect of metabolic syndrome was insignificant. These results are consistent with previous studies on obesity in patients undergoing TSA and may explain why recent studies have not shown differences in the rate of complications after TSA in obese patients with a body mass index of 30 to 40 mg/kg2.

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About the Author

Dr. Michael Fu is an orthopedic surgeon and shoulder specialist at the Hospital for Special Surgery (HSS), the best hospital for orthopedics as ranked by U.S. News & World Report. Dr. Fu treats the entire spectrum of shoulder conditions, including rotator cuff tears, shoulder instability, and shoulder arthritis. Dr. Fu was educated at Columbia University and Yale School of Medicine, followed by orthopedic surgery residency at HSS and sports medicine & shoulder surgery fellowship at Rush University Medical Center in Chicago. He has been a team physician for the Chicago Bulls, Chicago White Sox, DePaul University, and NYC’s PSAL.

Disclaimer: All materials presented on this website are the opinions of Dr. Michael Fu and any guest writers, and should not be construed as medical advice. Each patient’s specific condition is different, and a comprehensive medical assessment requires a full medical history, physical exam, and review of diagnostic imaging. If you would like to seek the opinion of Dr. Michael Fu for your specific case, we recommend contacting our office to make an appointment.

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Malnutrition: A Marker for Increased Complications, Mortality, and Length of Stay After Total Shoulder Arthroplasty

Authors

Grant H. Garcia, MD, Michael C. Fu MD, MHS, David M. Dines MD, Edward V. Craig MD, MPH, Lawrence V. Gulotta, MD

Journal

Journal of Shoulder and Elbow Surgery, 2016-02-01, Volume 25, Issue 2, Pages 193-200

Abstract

Background

Malnutrition is an established risk factor for postoperative complications. The purpose of this investigation was to determine the overall prevalence of malnutrition in total shoulder arthroplasty (TSA) patients, the differences in prevalence across obesity subgroups, and the overall complication risk of malnourished patients compared with normal patients.

Methods

The American College of Surgeons National Surgical Quality Improvement Program database was queried for TSA cases from 2005 to 2013 for this retrospective cohort study. Malnutrition was defined as preoperative albumin concentration of <3.5 g/dL. Rates of postoperative complications were compared between normal and malnourished patients.

Results

We identified 4,655 TSA cases, with preoperative albumin measurements available for 1681 patients (36.1%). Propensity score adjustment successfully reduced selection bias, with adjusted P values of >.05 for demographics, body mass index, and modified Charlson Comorbidity Index. Of the cohort with albumin measurements, 7.6% of patients were malnourished according to our criteria. Bivariate analysis showed malnourished patients had higher rates of pulmonary complications, anemia requiring transfusion, extended length of stay (LOS), and death (all P < .05). Propensity-adjusted multivariable logistic regression demonstrated that malnutrition was significantly associated (all P < .05) with postoperative transfusion (odds ratio, 2.49), extended LOS (odds ratio, 1.69), and death (odds ratio, 18.09).

Conclusion

The overall prevalence of malnutrition was 7.6%. Malnourished patients were at a significantly increased risk for blood transfusion, longer hospital LOS, and death within 30 days of surgery. Multivariable analysis showed TSA patients with preoperative albumin levels of <3.5 g/dL are at much higher risk for morbidity and death after surgery than patients with albumin levels within normal reference ranges.

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About the Author

Dr. Michael Fu is an orthopedic surgeon and shoulder specialist at the Hospital for Special Surgery (HSS), the best hospital for orthopedics as ranked by U.S. News & World Report. Dr. Fu treats the entire spectrum of shoulder conditions, including rotator cuff tears, shoulder instability, and shoulder arthritis. Dr. Fu was educated at Columbia University and Yale School of Medicine, followed by orthopedic surgery residency at HSS and sports medicine & shoulder surgery fellowship at Rush University Medical Center in Chicago. He has been a team physician for the Chicago Bulls, Chicago White Sox, DePaul University, and NYC’s PSAL.

Disclaimer: All materials presented on this website are the opinions of Dr. Michael Fu and any guest writers, and should not be construed as medical advice. Each patient’s specific condition is different, and a comprehensive medical assessment requires a full medical history, physical exam, and review of diagnostic imaging. If you would like to seek the opinion of Dr. Michael Fu for your specific case, we recommend contacting our office to make an appointment.

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