These authors reviewed 137 patients who underwent reverse total shoulder (RSA) for degenerative joint disease (86), rotator cuff tear (28) or rotator cuff tear arthropathy (23) from 2013 to 2016 with minimum of 2-year postoperative follow-up. Patients with intra- and postoperative complications were excluded.
Poor postoperative clinical outcome was defined as those patients within the bottom 30th percentile for American Shoulder and Elbow Surgeons (ASES) score.
Poor postoperative improvement was defined as the bottom 30th percentile of ASES improvement, measured preoperatively to the 2-year postoperative mark.
Multivariable logistic regression modeling found that prior shoulder surgery, the majority (75%) of which were arthroscopic, was the only independent factor associated with both poor improvement (adjusted odds ratio, 2.46 [1.03-5.83]) and outcome (adjusted odds ratio, 4.92 [1.74-14.96]). The majority of these surgeries were attempts at cuff repair.
Preoperative opioid use was associated with poor outcomes only, whereas the high preoperative ASES score was associated with poor postoperative improvement. Patients in the lowest improvement group (bottom 30%) had a preoperative ASES score of 42±15 in comparison to the 70% with satisfactory improvement which had a preoperative ASES score of 26±12.
Comment: This is an important type of study in which an individual surgeon examines their own practice, comparing those patients who do well with those who do less well in their own hands. The observations then inform their subsequent decision making as well as increasing the quality of discussions with their future patients about likely outcomes.
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