Saturday, August 8, 2015

Rotator cuff repair - a study with a confused design

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

These authors used the Veterans Administration Surgical Quality Improvement Program database from the entire U.S. Veterans Administration system to obtain perioperative data of all patients undergoing rotator cuff repair between 2003 and 2008. They stated that they performed single and multivariate analyses were performed to evaluate risk factors for perioperative complications associated with rotator cuff surgery.

Comment: The authors appear to have deviated from the initial desire to evaluate risk factors for complications and decided instead to compare the complications of  6975 open rotator cuff repairs and 2918 arthroscopic rotator cuff repairs, finding that complications occurred in the early postoperative period in 2.1% of the open repair group and 0.9% of the arthroscopic repair group (P < .0001) and came to the conclusion that "Arthroscopic rotator cuff repair in the veteran population resulted in a lower incidence of perioperative complications compared with open repair."

In comparing the arthroscopic and open groups, many significant differences surfaced: the patients having open surgery were older, smoked more, were more likely to be male, had worse ASA class, were more likely to have diabetes and strokes, and were operated on by less experienced resident surgeons. We can easily see that this is not a comparison of open and arthroscopic management because the patients and surgeons are not the same.

The proper study design would have been what was suggested in the title: univariate and multivariate analyses of those patients with and without complications (rather than comparing open and arthroscopic repairs). The authors have the data to do it right.


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