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Sandler AB, Green CK, Scanaliato JP, Fares AB, Dunn JC, Parnes N. The Influence of Obesity on Outcomes Following Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-Analysis of 118,331 Patients Internationally. JB JS Open Access 2024; 9:e23.00047. [PMID: 38638593 PMCID: PMC11023613 DOI: 10.2106/jbjs.oa.23.00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
Background Given the rising prevalence of obesity, the number of patients with obesity undergoing arthroscopic rotator cuff repair (RCR) will likely increase; however, there have been mixed results in the existing literature with regard to the effect of elevated body mass index (BMI) on functional outcomes and complications. Methods The patient-reported outcome measures included the visual analog scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, range of motion, and adverse events. Results Fourteen studies (118,331 patients) were included. There were significant decreases in VAS pain scores for both patients with obesity (mean difference, -3.8 [95% confidence interval (CI), -3.9 to -3.7]; p < 0.001) and patients without obesity (mean difference, -3.2 [95% CI, -3.3 to -3.1]; p < 0.001). There were also significant increases in ASES scores for both patients with obesity (mean difference, 24.3 [95% CI, 22.5 to 26.1]; p < 0.001) and patients without obesity (mean difference, 24.3 [95% CI, 21.4 to 26.0]; p < 0.001). There were also significant increases in ASES scores for both patients with obesity (mean difference, 24.3 [95% CI, 22.5 to 26.1]; p < 0.001) and patients without obesity (mean difference, 24.3 [95% CI, 21.4 to 26.0]; p < 0.001). However, there were no significant differences in final VAS pain scores, ASES scores, or range of motion between the groups. The mean rates of complications were higher among patients with obesity (1.2% ± 1.7%) than among patients without obesity (0.59% ± 0.11%) (p < 0.0001), and the mean rates of postoperative admissions were also higher among patients with obesity (5.9%) than patients without obesity (3.7%) (p < 0.0001). Although the mean rates of reoperation were similar between groups (5.2% ± 2.8% compared with 5.2% ± 4.2%), the meta-analysis revealed lower odds of reoperation in patients without obesity (odds ratio [OR], 0.76 [95% CI, 0.71 to 0.82]). Conclusions No significant or clinically important differences in postoperative pain, ASES scores, or range of motion were found between patients with and without obesity following arthroscopic RCR. However, populations with obesity had higher rates of complications, postoperative admissions, and reoperation following arthroscopic RCR. Level of Evidence Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alexis B. Sandler
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso County, Texas
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Clare K. Green
- School of Medicine and Health Sciences, The George Washington University, Washington, DC
| | - John P. Scanaliato
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois
| | - Austin B. Fares
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso County, Texas
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - John C. Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso County, Texas
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York
- Department of Orthopaedic Surgery, Claxton-Hepburn Medical Center, Ogdensburg, New York
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Su YC, Hsieh PC, Lai ECC, Lin YC. Risk of rotator cuff tear and rotator cuff repair surgery comparison between sodium-glucose cotransporter 2 inhibitors and glucagon like peptide-1 receptor agonists: A real-world study. DIABETES & METABOLISM 2024; 50:101522. [PMID: 38341131 DOI: 10.1016/j.diabet.2024.101522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
AIM Theoretically, sodium-glucose cotransporter 2 inhibitors (SGLT2is) reduce the risk of rotator cuff tear through an anti-inflammatory mechanism. To clarify this association, in this study, we compared SGLT2is users and glucagon-like peptide-1 receptor agonists (GLP-1RAs) users in terms of the risk of rotator cuff tear and the risk of receiving rotator cuff repair surgery. METHODS A retrospective cohort analysis was conducted using data from the TriNetX platform. A target trial design was adopted to identify patients with type 2 diabetes mellitus who started receiving SGLT2is or GLP-1RAs. Propensity score matching was used to form two homogeneous groups. The study outcomes were the risk of rotator cuff tear and the risk of receiving rotator cuff repair surgery. Hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated within the TriNetX platform. RESULTS Initially, 351,800 SGLT2is users and 387,616 GLP-1RAs users were identified. After propensity score matching, each group comprised 274,026 patients. The mean age was 59.5 years in both groups; the proportions of women in the SGLT2is and GLP-1RAs groups were 46.9 % and 46.7 %, respectively. Compared with the GLP-1RAs group, the SGLT2is group had significantly reduced risks of rotator cuff tear (HR 0.812 [0.761;0.867]) and rotator cuff repair surgery (HR 0.900 [0.815;0.994]). CONCLUSION SGLT2is appear to reduce the risk of rotator cuff tear and the risk of receiving rotator cuff repair surgery in patients with type 2 diabetes mellitus. Further prospective studies are needed to validate our findings.
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Affiliation(s)
- Yu-Chi Su
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Chun Hsieh
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Fassler R, Ling K, Burgan J, Komatsu DE, Wang ED. Components of metabolic syndrome as significant risk factors for postoperative complications following total shoulder arthroplasty: hypertension, diabetes, and obesity. JSES Int 2024; 8:141-146. [PMID: 38312290 PMCID: PMC10837726 DOI: 10.1016/j.jseint.2023.08.019] [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: 02/06/2024] Open
Abstract
Background Metabolic syndrome (MetS) is a known risk factor for adverse postoperative outcomes. However, the literature surrounding the effects of MetS on orthopedic surgery outcomes following total shoulder arthroplasty (TSA) remains understudied. The purpose of this study is to investigate the effect of MetS on postoperative 30-day adverse outcomes following TSA. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent TSA between 2015 and 2020. After exclusion criteria, patients were divided into MetS and no MetS cohorts. MetS patients were defined as presence of hypertension, diabetes, and body mass index > 30 kg/m2. Bivariate logistic regression was used to compare patient demographics, comorbidities, and complications. Multivariate logistic regression, adjusted for all significant patient demographics and comorbidities, was used to identify the complications independently associated with MetS. Results A total of 26,613 patients remained after exclusion criteria, with 23,717 (89.1%) in the no MetS cohort and 2896 (10.9%) in the MetS cohort. On multivariate analysis, MetS was found to be an independent predictor of postoperative pneumonia (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.02-2.55; P = .042), renal insufficiency (OR 4.09, 95% CI 1.67-10.00; P = .002), acute renal failure (OR 4.17, 95% CI 1.13-15.31; P = .032), myocardial infarction (OR 2.11, 95% CI 1.21-3.69; P = .009), nonhome discharge (OR 1.41, 95% CI 1.24-1.60; P < .001), and prolonged hospital stay > 3 days (OR 1.44, 95% CI 1.25-1.66; P < .001). Conclusion MetS was identified as an independent risk factor for postoperative pneumonia, renal insufficiency, acute renal failure, myocardial infarction, nonhome discharge, and prolonged hospital stay following TSA. These findings encourage physicians to medically optimize MetS patients prior to surgery to limit adverse outcomes.
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Affiliation(s)
- Richelle Fassler
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Kenny Ling
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - Jane Burgan
- Renaissance School of Medicine at 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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Yang Z, Chen W, Liang J, Liu T, Zhang B, Wang X, Yang X, Fang S, Daoji C, Yin X, Jiang J, Yun X. Association of obesity with high retears and complication rates, and low functional scores after rotator cuff repair: a systematic review and meta-analysis. J Shoulder Elbow Surg 2023; 32:2400-2411. [PMID: 37419440 DOI: 10.1016/j.jse.2023.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/07/2023] [Accepted: 05/21/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Obesity influences the outcomes of orthopedic surgeries such as total knee arthroplasty and spinal surgery. However, the effect of obesity on the outcomes of rotator cuff repair is unknown. This systematic review and meta-analysis aimed to examine the effect of obesity on rotator cuff repair outcomes. METHODS PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched to identify relevant studies published from their inception till July 2022. Two reviewers independently screened titles and abstracts using the specified criteria. Articles were included if they indicated the effect of obesity on rotator cuff repair and the related outcomes after surgery. Review Manager 5.4.1 software was used to perform statistical analysis. RESULTS Thirteen articles involving 85,497 patients were included. Obese patients had higher retear rates than nonobese patients (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.23-5.41, P = .01), lower American Shoulder and Elbow Surgeons scores (mean difference [MD]: -3.59, 95% CI: -5.45 to [-1.74]; P = .0001), higher visual analog scale for pain (mean difference: 0.73, 95% CI: 0.29-1.17; P = .001), higher reoperation rates (OR 1.31, 95% CI 1.21-1.42, P < .00001), and higher rates of complications (OR 1.57, 95% CI 1.31-1.87, P = .000). Obesity did not affect the duration of surgery (MD: 6.03, 95% CI: -7.63 to 19.69; P = .39) or external rotation of the shoulder (MD: -1.79, 95% CI: -5.30 to 1.72; P = .32). CONCLUSION Obesity is a significant risk factor for retear and reoperation after rotator cuff repair. Furthermore, obesity increases the risk of postoperative complications and leads to lower postoperative American Shoulder and Elbow Surgeons scores and higher shoulder visual analog scale for pain.
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Affiliation(s)
- Zhitao Yang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Wei Chen
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Junwen Liang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Tao Liu
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Borong Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xihao Wang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xudong Yang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Sen Fang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Cairang Daoji
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xiaoli Yin
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Jin Jiang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
| | - Xiangdong Yun
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
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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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Parnes N, Scanaliato JP, Dunn JC, Fink WA, Sandler A, Fares AB. Obesity negatively affects outcomes following arthroscopic rotator cuff repair at four-year follow-up. Shoulder Elbow 2023; 15:46-52. [PMID: 37974610 PMCID: PMC10649479 DOI: 10.1177/17585732221095846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 11/19/2023]
Abstract
Introduction The purpose is to evaluate the influence of obesity (BMI 30 to 39.9 kg/m2) on surgical outcomes following arthroscopic rotator cuff repair surgery. Materials and Methods A retrospective review was performed examining the outcomes of arthroscopic rotator cuff repair in both a normal weight (BMI 18.5 to 24.9 kg/m2) and an obese (BMI 30 to 39.9 kg/m2) patient population, specifically looking at functional outcomes and range of motion. Secondary variables analyzed were surgical time, complications, and medical comorbidities. Results 52 normal weight patients (mean BMI 23.7 ± 2.1) and 59 obese patients (mean BMI 34.0 ± 2.4) were included. Both groups demonstrated statistically significant improvements in VAS, SANE and ASES scores (P < 0.0001), however there were significantly better outcomes in the normal weight group in VAS (0.56 ± 0.96 vs 1.42 ± 2.22; P = 0.0108), ASES (96.1 ± 5.8 vs 90.6 ± 15.6; P = 0.0192), and internal rotation (9.2 ± 3.0 vs 10.9 ± 2.3; P = 0.0010). Additionally, the obese cohort had more complications, longer surgical times, and a greater comorbid background. Conclusions Obesity is associated with significantly more comorbid conditions, surgical complications, longer surgical time, and worse patient reported outcomes than normal weight patients undergoing arthroscopic rotator cuff repair.
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Affiliation(s)
- Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital. Carthage, NY, USA
| | - John P Scanaliato
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas, USA
| | - John C Dunn
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas, USA
| | - Walter A Fink
- Department of Orthopaedic Surgery, Carson Tahoe Health, Carson City, Nevada, USA
| | - Alexis Sandler
- Department of Orthopaedic Surgery, George Washington University School of Medicine, Washington, DC, USA
| | - Austin B Fares
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas, USA
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Sumbal R, Sumbal A, Amir A. Risk factors for 30-day readmission following shoulder arthroscopy: a systematic review. J Shoulder Elbow Surg 2023; 32:2172-2179. [PMID: 37263483 DOI: 10.1016/j.jse.2023.04.027] [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] [Received: 02/19/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Recently, there has been a rapid shift from open shoulder surgery to arthroscopic shoulder procedures for treating several shoulder pathologies. This shift is mainly due to reduced postoperative complications and 30-day readmission. Although the 30-day readmission rate is low, the risk still exists. One way to minimize the risk factors is to analyze all the risk factors contributing to the 30-day readmission following shoulder arthroscopy. METHODS Electronic databases such as PubMed, Google Scholar, and Cochrane library were searched. Studies were selected based on predefined inclusion and exclusion criteria. Newcastle-Ottawa score was used for the quality assessment of individual studies. Two reviewers extracted data from the selected studies. Results were evaluated through narrative analysis and presented as an odds ratio with 95% confidence interval. A meta-analysis was not possible due to the heterogeneity in the available data. RESULTS A total of 12 studies evaluating 494,038 patients were selected in our review. All the studies have a low risk of bias (median = 8). Significant factors predicting readmission included age, gender, COPD (chronic obstructive pulmonary disorder), steroid use, smoking, preoperative opioid use, higher American Society of Anesthesiologists (ASA) score (3 or higher), and general and regional anesthesia vs. regional anesthesia alone. CONCLUSION Through our systematic review, we tried to identify risk factors that can predict 30-day readmission following shoulder arthroscopy. These include age > 65 years, COPD, steroid use, opioid use, and OR time > 90 mins. These high-risk patients could be triaged earlier by identifying these parameters, and effective pre and post-operative surveillance could minimize 30-day readmission risk following shoulder arthroscopy.
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Affiliation(s)
- Ramish Sumbal
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Anusha Sumbal
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Alina Amir
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Papalia AG, Romeo PV, Gambhir N, Alben MG, Chowdhury T, Simcox T, Rokito A, Virk MS. Effects of increased body mass index on one year outcomes following soft tissue arthroscopic shoulder instability repair. JSES Int 2023; 7:730-736. [PMID: 37719813 PMCID: PMC10499852 DOI: 10.1016/j.jseint.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background The purpose of this study was to investigate the impact of high body mass index on the 1-year minimal outcome following arthroscopic shoulder stabilization. Methods Patients who underwent arthroscopic Bankart repair (ABR) between 2017 and 2021 were identified and assigned to 1 of 3 cohorts based on their preoperative body mass index: normal (18-25), overweight (25-30), and obese (>30). The primary outcomes assessed were postoperative shoulder instability and revision rates. The 3 groups were compared using the Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity, pain interference, pain intensity, Clinical Global Impression scores, visual analog scale pain scores, and shoulder range of motion at 1 year postoperatively. Results During the study period, 142 patients underwent ABR and had an average age of 35 ± 10 years. Obese patients had a higher percentage of partial rotator cuff tears (60% vs. 27%, odds ratio: 3.2 [1.1, 9.2]; P = .009), longer mean operative time (99.8 ± 40.0 vs. 75.7 ± 28.5 minutes; P < .001), and shorter time to complication (0.5 ± 0 vs. 7.0 ± 0 months; P = .038). After controlling for confounding factors, obesity was associated with a lesser improvement in upper extremity function scores (obese vs. normal: -4.9 [-9.4, -0.5]; P = .029); although this difference exists, found future studies are needed to determine the clinical significance. There were no differences in patient reported outcome measures, recurrence rate, or revision surgery rates between cohorts at any time point (P > .05). Conclusion Obesity is an independent risk factor for longer operative times but does not confer a higher risk of recurrent instability, revision surgery, or lower outcome scores 1 year following ABR.
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Affiliation(s)
- Aidan G. Papalia
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Paul V. Romeo
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Neil Gambhir
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Matthew G. Alben
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Tas Chowdhury
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Trevor Simcox
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Andrew Rokito
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Mandeep S. Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
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Fares AB, Scanaliato JP, Green CK, Dunn JC, Gordon M, Parnes N. The Effect of the Overweight Condition on Arthroscopic Rotator Cuff Repair Outcomes. Orthopedics 2023; 46:242-249. [PMID: 36719410 DOI: 10.3928/01477447-20230125-07] [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] [Indexed: 02/01/2023]
Abstract
This study sought to investigate the influence of a preexisting overweight condition (body mass index [BMI], 25-29.9 kg/m2) on functional outcomes after arthroscopic rotator cuff repair surgery. A retrospective review was performed examining the outcomes of arthroscopic rotator cuff repair in a normal-weight (BMI, 18.5-24.9 kg/m2) and an overweight (BMI, 25-29.9 kg/m2) population. Functional outcomes were assessed to include the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation score, and the visual analog scale (VAS) pain score, as well as range of motion in forward flexion, external rotation, and internal rotation. A total of 52 normal-weight patients (mean BMI, 23.7±2.1 kg/m2) and 57 overweight patients (mean BMI, 28.4±1.4 kg/m2) were included. Both groups demonstrated statistically and clinically significant improvements in VAS score, Single Assessment Numeric Evaluation score, and ASES score at final follow-up (P<.0001), with no difference in range of motion (P>.05). Overall, when comparing outcomes between the groups, there were significantly better outcomes in the normal-weight group's VAS scores (mean, 0.56±0.96 vs 1.3±1.7; P=.0064), ASES scores (mean, 96.1±5.8 vs 92.4±9.7; P=.0187), and internal rotation (mean thoracic vertebrae, 9.2±3.0 vs 10.4±2.6; P=.0289). However, these differences did not reach clinical significance regarding the threshold of patients meeting standard minimal clinically important difference, substantial clinical benefit, and patient-acceptable symptomatic state for rotator cuff repairs. Over-weight patients have improved outcomes after arthroscopic rotator cuff repair surgery with noninferior clinical results when compared with normal-weight patients. More data regarding outcomes of overweight patients will help physicians make better-informed decisions when considering rotator cuff repair. [Orthopedics. 2023;46(4):242-249.].
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Livesey MG, Weir TB, Addona JL, Curto RA, Apte A, Hughes M, Enobun B, Henn RF, Hasan SA, Gilotra MN. The Effect of Patients' Understanding of Sling Necessity and Home Assistance on Sling Wear After Shoulder Surgery. Am J Sports Med 2023; 51:179-186. [PMID: 36349935 DOI: 10.1177/03635465221131984] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Perioperative education and socioeconomic factors influence patient behavior. Recent evidence has suggested that sling compliance is associated with improved outcomes after shoulder surgery; it is important to investigate factors that influence sling compliance. PURPOSE To determine the associations between postoperative sling wear and patients' understanding of sling necessity, postoperative home assistance, and social deprivation. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 66 patients were prospectively enrolled from 2018 to 2020 if they were ≥18 years of age and undergoing shoulder surgery requiring a sling for at least 1 month postoperatively. Sling wear was measured using a temperature-sensing device. At 6 weeks postoperatively, patients' understanding for sling necessity was determined by their response to a question on the Medical Adherence Measure questionnaire, "Why did you have to wear a shoulder sling?" The Patient Understanding Grading Scale (PUGS) was developed to quantify patient responses. PUGS was graded 1 to 3, with grade 1 corresponding to the least technical knowledge. Patient characteristics, social deprivation (Area Deprivation Index [ADI]), and home assistance were additionally analyzed. RESULTS There were no significant differences in baseline characteristics between patients when stratified by PUGS grade. Multivariable linear regression analysis for total hours of sling wear per week showed that patients with PUGS grade 2 (β, 48.2 hours; P = .007) and grade 3 (β, 59.5 hours; P = .003) wore their slings significantly more than grade 1 patients. Patients with home assistance had significantly greater day hours (73.5 ± 33.0 vs 44.0 ± 24.5 hours; P = .037) of sling wear per week, but there was no difference in night sling hours. Patients older than 60 years wore their slings significantly more, while men and those with a higher body mass index (BMI) wore their slings significantly less. ADI was not significantly associated with sling wear. CONCLUSION This study demonstrates that patients with greater understanding for sling necessity, those with home assistance, and patients >60 years have greater sling wear, while male patients and those with a higher BMI have lower sling compliance. ADI was not a significant contributor.
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Affiliation(s)
- Michael G Livesey
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Tristan B Weir
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jacqueline L Addona
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ryan A Curto
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anuj Apte
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Marcus Hughes
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Blessing Enobun
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
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11
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Huang H, Jiesisibieke D, Zhou X, Zhang Z, Duan X, Cheng X, Shao Z, Wang J, Zhang X. A lipid metabolite lipidomics assay for prediction and severity evaluation of rotator cuff injury. Front Nutr 2022; 9:1000947. [PMID: 36211515 PMCID: PMC9537637 DOI: 10.3389/fnut.2022.1000947] [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: 07/22/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveRotator cuff injury can be caused by local inflammation and fibrosis of musculotendinous cuff. Hypercholesterolemia can lead to physiological changes of rotator cuff that resemble rotator cuff injury. However, the relationship between lipid metabolism and rotator cuff injury and its potential pathological mechanism remain unclear. Herein, we aimed to investigate the correlation between the plasma lipidome, rotator cuff injury, and successive fatty infiltration pathology, and hoped to identify biomarkers for predicting higher risk or higher severity rotator cuff injury by assessing metabolic perturbations and dyslipidemia using lipidomics.MethodsWe quantitatively analyzed 60 lipids species of seven lipids classes and subclasses from 66 subjects using lipidomics. Subjects were divided into four groups: (1) normal rotator cuff with normal clinical routine serum lipid test results (NN group = 13); (2) normal rotator cuff with abnormal clinical routine serum lipid test results (NA group = 10); (3) rotator cuff tear with normal routine serum lipid test results (RN group = 30); (4) rotator cuff tear with abnormal routine serum lipid test results (RA group = 13). Independent-sample t-tests and Kruskal-Wallis tests were used to compare lipid metabolite levels in serum between different groups in patients with rotator cuff tears. The orthogonal partial least squares-discriminant analysis (OPLS-DA) model was used to verify the ability of five lysophosphatidylcholines (LPCs) to distinguish rotator cuff injuries. In the rotator cuff tear group, magnetic resonance imaging (MRI) was used to classify fatty infiltration according to Goutallier's classification. Kruskal-Wallis tests were used to analyze molecular differences between high-grade (grade 3–4) and low-grade (grade 0–2) fatty infiltration groups. Receiver operator characteristic (ROC) curves were drawn for each diagnostic method via different metabolites. The area under the curve (AUC), cutoff, specificity, sensitivity, and accuracy of each diagnostic criterion were calculated.ResultsOur results showed that some rotator cuff injury patients yielded unique lipidomic profiles. Based on Kruskal-Wallis tests, our results showed significant differences in three lipid molecules, 17:1 Lyso PI, 18:0–22:6 PE, and 18:3 (Cis) PC, among all four groups independent of clinical blood lipid levels. Also, independent of clinical blood lipid levels, two lipid molecules, 22:0 Lyso PC and 24:0 Lyso PC, were significantly different between the two groups based on Independent sample t-tests. Kruskal-Wallis test results showed that in the rotator cuff tear group, two metabolites (24:0 SM and 16:0 ceramide) differed between high-grade and low-grade fatty infiltration. The AUC values for 22:0 Lyso PC, 24:0 Lyso PC, 18:0–22:6 PE, 24:0 SM, and 16:0 ceramide were 0.6036, 0.6757, 0.6712, 0.8333, and 0.8981, respectively.ConclusionThe results provide insight into how the metabolic mechanisms associated with dyslipidemia impact rotator cuff diseases. Five lipid molecules, 17:1 Lyso PI, 18:0–22:6 PE, 18:3 (Cis) PC, 22:0 Lyso PC, and 24:0 Lyso PC, were closely related to rotator cuff tear based on two statistical analysis methods, independent of clinical routine serum lipid test results, which indicates that lipidomics assays are more sensitive than conventional lipid tests, and more suitable for studying rotator cuff lipid metabolism. In addition, two lipid metabolites, 24:0 SM and 16:0 ceramide, are potentially useful for predicting fatty infiltration severity. Further research with a larger number of samples is needed to verify whether these two metabolites can serve as potential markers of severe fatty infiltration. The findings illuminate how metabolic mechanisms associated with dyslipidemia affect rotator cuff disease.
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Affiliation(s)
- Hongjie Huang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Dina Jiesisibieke
- School of Clinical Medicine, Peking University Health Science Center, Beijing, China
| | - Xiang Zhou
- School of Clinical Medicine, Peking University Health Science Center, Beijing, China
| | - Zhu Zhang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Xiaoning Duan
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Xu Cheng
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Zhenxing Shao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Jianquan Wang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- *Correspondence: Jianquan Wang
| | - Xin Zhang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Xin Zhang
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12
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Fares AB, Scanaliato JP, Gavalas A, Dunn JC, Czajkowski H, Parnes N. Severe Obesity Is Not Associated With Worse Functional Outcomes Following Arthroscopic Rotator Cuff Repair. Arthroscopy 2022; 38:2602-2608. [PMID: 35278599 DOI: 10.1016/j.arthro.2022.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to investigate the outcomes of arthroscopic rotator cuff repair in a severely obese population (body mass index [BMI] > 0 kg/m2) compared to a healthy weight population (BMI 18.5-24.9 kg/m2). METHODS This study is a retrospective review of prospectively collected data examining the outcomes of arthroscopic rotator cuff repair in both severely obese patients and healthy weight patients. Primary outcome measures analyzed include the American Shoulder and Elbow Surgeons (ASES) Score, the Single Assessment Numeric Evaluation (SANE), pain Visual Analog Scale (VAS), range of motion, and complications. RESULTS A total of 89 patients met inclusion/exclusion criteria: 52 healthy weight patients (BMI 18.5-24.9 kg/m2) and 37 severely obese patients (BMI >40 kg/m2). Patient-reported pain and functional outcomes had significantly improved after surgery in both groups with regard to the visual analog score (VAS) scores, Single Assessment Numeric Evaluation (SANE) scores, and American Shoulder and Elbow Surgeons Shoulder (ASES) scores (P < .0001). When directly comparing the outcomes in the healthy weight group to the severely obese group, the latter had significantly inferior outcomes in VAS scores (P = .0048), SANE scores (P = .0118), ASES scores (P = .0031), and postoperative internal rotation (P =.0132). At large, these outcomes did not have clinically significant differences. The severely obese group also had higher total numbers of comorbid conditions and longer operative times (P =.0041). CONCLUSIONS Severely obese patients and their associated comorbid conditions pose unique challenges in rotator cuff tear management, but they still achieve overall excellent outcomes after repair and noninferior clinical differences when compared to healthy weight patients. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Austin B Fares
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas.
| | - John P Scanaliato
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas
| | - Anthony Gavalas
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas
| | - John C Dunn
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas
| | - Hunter Czajkowski
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York; Department of Orthopaedic Surgery, Claxton-Hepburn Medical Center, Ogdensburg, New York
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13
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Hall A, Lee D, Campbell R, Palm J, Tucker B, Pepe M, Tjoumakaris F. The Shoulder Function “Tipping-Point” for Elective Rotator Cuff Repair: Demographic and Longitudinal Trends. JSES Int 2022; 6:828-832. [PMID: 36081700 PMCID: PMC9446187 DOI: 10.1016/j.jseint.2022.05.004] [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] [Indexed: 11/16/2022] Open
Abstract
Background A patient's decision to undergo an elective orthopedic procedure is largely based on their symptoms and functional limitations. This point where patients choose to undergo surgery is known as the “tipping point.” The primary aim of this study is to determine the relationship between demographic parameters and the tipping point for elective rotator cuff repair. The secondary aim is to investigate if the tipping point is associated with mental health. The tertiary aim is to determine if the tipping point changes over time. Methods Retrospective chart review was used to identify all patients who underwent primary arthroscopic rotator cuff repair between January 1, 2015, to January 1, 2020, with 1 of 3 board-certified orthopedic surgeons. Exclusion criteria included age <18 years, revision surgery, or incomplete datasets (American Shoulder and Elbow Surgeons [ASES], 12-item short form, demographic information, and surgical history). Preoperative ASES score was designated as the tipping point for an individual patient, with a lower score representing worse shoulder function and therefore a higher tipping point and vice versa. Demographic parameters (age, sex, body mass index [BMI], race, and insurance), hand dominance, and surgical history extracted from chart review were analyzed to determine associations with tipping point. Results A total of 2153 patients were identified from chart review, with 1731 included in the final analysis. The patients had a mean age of 58.6 ± 9.66 years and a mean BMI of 29.2 ± 6.02 kg/m2. There was no significant difference in mean preoperative ASES score by year for the duration of this study (2015-2019, P = .27). Worker's compensation patients had a significantly lower mean preoperative ASES score than patients with commercial or government insurance (P < .01). Spearman's rank correlations showed no relationship between ASES score and patient demographics (age, sex, BMI, race, and hand dominance) or between ASES and previous orthopedic surgery. Preoperative ASES showed a weakly positive correlation (ρ = 0.26) with 12-item short form mental component score. Multivariate linear regression showed male sex is predictive of a lower tipping point (P < .01), whereas higher BMI, African American race, and history of arthroplasty are predictive of a higher tipping point (P ≤ .02). Conclusion The tipping point was not demonstrated to change over time in our analysis. Male sex is predictive of a lower tipping point for arthroscopic rotator cuff repair, whereas elevated BMI, African American race, worker's compensation insurance, and prior arthroplasty are predictive of a higher tipping point. Also, better mental health function is associated with a lower tipping point.
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14
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Gambhir N, Shankar D, Alben M, Kwon Y, Rokito A, Virk MS. The Effects Of Obesity On 1 Year Functional Outcomes Following Arthroscopic Rotator Cuff Tear Repair. JSES Int 2022; 6:631-637. [PMID: 35813139 PMCID: PMC9264002 DOI: 10.1016/j.jseint.2022.04.004] [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] [Indexed: 11/19/2022] Open
Abstract
Background The purpose of our study was to examine the impact that an increased body mass index (BMI) has on arthroscopic rotator cuff repair (aRCR) outcomes. Methods We identified a sample of 313 patients who underwent aRCR at our institution from 2017 to 2020. Patients were classified into cohorts by BMI: normal BMI (<25), overweight (25-30), and obese (≥30). Patient-Reported Outcomes Measurement Information System (PROMIS) scores (Pain Interference, Pain Intensity, and Upper Extremity) and Clinical Global Impressions scale rating of pain and functional improvement after surgery were obtained at 1 year postoperatively. The significance of the BMI category as a predictor for outcomes was evaluated using multiple linear and multivariable logistic regressions. Receiver operating characteristic curve analysis with Youden’s J-statistic was used to determine optimal BMI cutoff for predicting likelihood of achieving minimum clinically important difference (MCID) and substantial clinical benefit (SCB) on the Clinical Global Impressions scales. Results Obesity was a significant predictor of reduced preoperative-to-postoperative improvement in the PROMIS Upper Extremity score (P = .04). However, BMI was not predictive of other preoperative-to-postoperative differences in outcome scores or the size and number of cuff tendons torn (P > .05). Optimal BMI cutoffs were determined for pain MCID (40.8), pain SCB (26.8), function MCID (27.4), and function SCB (26.8), but all cutoffs had low correct classification rates (≤13%). Discussion and Conclusion Obesity was not found to be an independent risk factor for increased rotator cuff tear size or tendon involvement but was nonetheless associated with worse upper extremity function and pain after aRCR.
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Affiliation(s)
| | | | | | | | | | - Mandeep S. Virk
- Corresponding author: Mandeep S. Virk, MD, Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery at NYU Grossman School of Medicine, 333 East 38th St, New York, NY 10016, USA.
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15
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Johnson AH, Parkison A, Petre BM, Turcotte JJ, Redziniak DE. Racial disparities in outcomes of arthroscopic rotator cuff repair: A propensity score matched analysis using multiple national data sets. J Orthop 2022; 30:103-107. [PMID: 35250198 PMCID: PMC8894139 DOI: 10.1016/j.jor.2022.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/09/2022] [Accepted: 02/19/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Disparities in access, utilization and outcomes exist throughout the healthcare system for minority groups, including racial and ethnic minorities; these disparities have wide-reaching implications for individuals as well as the healthcare system as a whole. This study will examine the impact of race on short and medium term outcomes for patients undergoing rotator cuff repair (RCR) using matched cohorts. METHODS Patients undergoing arthroscopic rotator cuff repair from 2016 to 2018 were extracted from two national databases: the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and TriNetX Research Network. Using the ACS-NSQIP database, univariate analysis was performed to identify differences in comorbidities between white and minority patients. Patients were propensity score matched based on significant differences between groups and 30-day postoperative outcomes were assessed. These comorbidities were then used to propensity score match white and minority patients in the TriNetX database and two-year postoperative outcomes were evaluated. RESULTS Following propensity score matching, 3716 patients remained in each group from the ACS-NSQIP database and 4185 patients remained in each group from the TriNetX database. The OR time for minority patients was longer than white patient in the ACS-NSQIP database (92.2 vs. 87.6 min, p < .001). There was no difference in medium-term outcomes for repeat RCR, infection or frozen shoulder between white and minority patients in the TriNetX database. CONCLUSION After propensity score matching the only significant short-term outcome between white and minority patients undergoing RCR was a difference in OR time; there were no differences in medium-term outcomes. This may indicate that the source of racial disparities is one of access to healthcare rather than an innate difference in the patients' outcomes. Further study is needed to elucidate this issue.
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Affiliation(s)
| | | | | | - Justin J. Turcotte
- Corresponding author. 2000 Medical Parkway Suite 503, Annapolis, MD, 21401, USA.
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Machine Learning Model Identifies Increased Operative Time and Greater BMI as Predictors for Overnight Admission After Outpatient Hip Arthroscopy. Arthrosc Sports Med Rehabil 2022; 3:e1981-e1990. [PMID: 34977657 PMCID: PMC8689272 DOI: 10.1016/j.asmr.2021.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/06/2021] [Indexed: 01/05/2023] Open
Abstract
Purpose The purposes of this study were to identify patient characteristics and risk factors for overnight admission following outpatient hip arthroscopy and to develop a machine learning algorithm that can effectively identify patients requiring admission following elective hip arthroscopy. Methods A retrospective review of a prospectively collected national surgical outcomes database was performed to identify patients who underwent elective outpatient hip arthroscopy from 2006 to 2018. Patients admitted overnight postoperatively were identified as those with length of stay of 1 or more days. Models were generated using random forest (RF), extreme gradient boosting (XGBoost), adaptive boosting (AdaBoost), elastic net penalized logistic regression, and an additional model was produced as a weighted ensemble of the four final algorithms. Results Overall, 1,276 patients were included. The median age was 43 years, and 64.2% (819) were female. Of the included patients, 109 (8.5%) required an overnight stay following elective outpatient hip arthroscopy. The most important factors for inpatient admission were increasing operative time, general anesthesia, age extremes, male gender, greater body mass index (BMI), American Society of Anesthesiologists classification >1, and the following preoperative lab values outside of normal ranges: sodium, platelet count, hematocrit, and leukocyte count. The ensemble model achieved the best performance based on discrimination assessed via internal validation (area under the curve = .71), calibration, and decision curve analysis. The model was integrated into a Web-based open-access application able to provide both personalized predictions and explanations. Conclusion A machine learning algorithm developed based on preoperative features identified increasing operative time, age extremes, greater BMI, sodium, hematocrit, platelets, and leukocyte count as the most important variables associated with inpatient admission with fair validity.
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