The Effect of Socioeconomic Status on Patient Outcomes Following Rotator Cuff Repair at Two Hospital Campuses

INTRODUCTION: To examine the relationship between demographics, socioeconomic status (SES), and patient outcomes after rotator cuff repair (RCR). METHODS: A retrospective review identified 7564 patients who underwent RCR between 2017 and 2021. Patients were stratified into two groups, urban(U) or suburban(S), based on which campus they underwent surgery. Demographic information, medical comorbidities, SES and other preoperative risk factors were compared. Pre- and postoperative functional outcomes at each location were analyzed. Categorical variables were reported as counts and percentages while continuous variables were reported as means and standard deviations. Chi-square tests were used to compare categorical variables while independent sample t-tests were used to compare continuous variables. Functional scores were analyzed using the Pearson Correlation. Statistical significance was set at \u3c0.05. RESULTS: 7564 cases were included. 5932(78.4%) were performed at S, and 1632(21.6%) were performed at U. Significant demographic differences exist in gender, race, marital status and employment(p \u3c0.001). Socioeconomic status(SES), education(p=0.023) and poverty level(p\u3c0.001), also varied. There was a difference in comorbidity index between locations(p\u3c0.001). More patients smoked tobacco at U(p\u3c 0.001). Patients at U showed worse postoperative patient-reported outcomes for pain and upper-extremity function(p=0.01,p\u3c0.001) and had longer postoperative stays(p=0.19). DISCUSSION: Although there was a size discrepancy between patient populations, significant differences in patient-reported outcomes for RCR may be attributable to several of these factors and should be addressed in pre-operative planning. SIGNIFICANCE: It is imperative to account for all patient risk factors preoperatively to limit discrepancies in outcomes and optimize results for all patients

The Impact of External Beam Radiation Therapy on Shoulder Surgical Outcomes: A Case Series Study

PURPOSE: External beam radiation therapy (XRT) is a commonly used treatment adjunct in patients with breast cancer, and is known to cause soft tissue dysfunction. However, data on XRT as a preoperative risk factor for shoulder surgery is limited. The purpose of this study is to assess whether prior history of breast cancer treated with XRT has an impact on surgical complications or outcomes. METHODS: A 20-year, retrospective chart review across one large, academic health care system was performed. Inclusion criteria comprised any patient with history of breast cancer of the upper-outer or axillary region treated with XRT. Patients also must have undergone a surgical procedure to the ipsilateral shoulder with at least 1-year postoperative follow-up. Patients were stratified by demographics, hand-dominance, and surgery type. Postoperative outcomes including range of motion (ROM) and visual analogue scale (VAS) for pain were also collected. RESULTS: Eighteen patients were identified (100% female) with an average age of 66.3 years (standard deviation 10.5 years). Ten shoulders underwent rotator cuff repair (RCR), four total shoulder arthroplasty (TSA), three Reverse Shoulder Arthroplasty (RSA) and one arthroscopic superior labrum anterior and posterior (SLAP) repair. Four patients treated with RCR (40%) experienced postoperative complications related to their procedure. These included scapular winging, adhesive capsulitis, stiffness, and one re-tear. Two patients treated with shoulder arthroplasty (28.6%) experienced postoperative complications which included lymphedema and peri-prosthetic fracture following a mechanical fall in one RSA patient and peri-prosthetic infection in one TSA patient. ROM across all groups improved, most significantly in forward flexion and internal rotation among RCR patients (p\u3c0.001). Furthermore, a statistically significant improvement in VAS scores was achieved in each group (6.2 ± 2.14 preop, 1.06 ± 1.75 postop p\u3c0.001). CONCLUSION: When compared to national averages, complication rates in our cohort were higher (40% vs. 10-17% in RCR patients and 28.6% vs. 4-14% in arthroplasty patients). Upon further scrutiny, many of these complications were independent of a history of XRT and many resolved with appropriate therapy. Most importantly, functional outcomes as measured by ROM and pain scores showed appropriate improvement consistent with normal populations without history of XRT. Thus, our results suggest that performing shoulder surgery after ipsilateral XRT for breast cancer is likely safe, may offer improved pain and improved ROM compared to forgoing surgery without necessarily increasing the risk for postoperative complication