Wednesday, July 19, 2017

Rotator cuff repair, arthroscopic or open?

Arthroscopic Versus Open Rotator Cuff Repair: Which Has a Better Complication and 30-Day Readmission Profile? 

These authors sought to compare the 30-day postoperative complications and unplanned readmission rates, using the National Surgical Quality Improvement Program database, after open or arthroscopic rotator cuff repair (RCR) performed from 2007 through 2014. 
The open group contained 3,590 cases (21.8%) and the arthroscopic group had 12,882 cases (78.2%), for a total of 16,472 patients undergoing RCR. 

They found that the open RCR group had a higher prevalence of patients aged 65 years or older and comorbidities such as hypertension, diabetes, chronic obstructive pulmonary disease, smoking, and alcoholism (P < .05).

These patients had a higher risk of any adverse event when compared with arthroscopic RCR patients (1.48% vs 0.84%; RR, 1.17; 95% CI, 1.05-1.30; P ¼ .0010). They were also at higher risk of return to the operating room within 30 days (0.70% vs 0.26%; RR, 1.36; 95% CI, 1.09-1.69; P ¼ .0004). Open RCR patients had longer average hospital stay (0.48 2.7 days vs 0.23 4.2 days, P ¼ .0007), whereas arthroscopic RCR had a longer average operative time (90 ± 45 minutes vs 79 ± 45 minutes, P < .0001). 

Comments: Although the authors concluded that "arthroscopy was associated with lower risks of any adverse event and return to the operating room during the initial 30-day postoperative period", this is not actually a comparison of two methods of cuff repair, it is a comparison of two populations of patients, one older and sicker and one younger and healthier. It is not unexpected that the first group had more complications and longer stays overall.

In addition, it is of interest that some of the complications were more prevalent in the arthroscopic group, including thromboembolic events.

It would be of interest to see a multivariate analysis of the effect of the preoperative age and health of the patient on each of these complications.

In conclusion, these data do not provide an argument for arthroscopic RCR as opposed to open surgery. Such an argument would need to be based on a matched set of patients, which was not used in this study.

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