Co-morbidities for Negative Outcome
We cannot recommend for or against advising patients in regard to the following factors related to rotator cuff surgery: Diabetes, Co-morbidities, Smoking, Prior Shoulder Infection, Cervical Disease.
Rationale
Various patient-related factors may influence clinical outcomes after rotator cuff surgery. These factors may affect functional outcomes or tendon healing, hence the work group systematically searched for data on diabetes, smoking, co morbidities, prior shoulder infection and cervical disease.
Two Level III studies97, 98 compared the outcomes of diabetic and non-diabetic individuals after rotator cuff surgery. One study98 found no statistically significant difference between the two groups on postoperative stiffness using the Constant Murley Score at 46 months. The second study97 found a statistically significant difference and possible clinically important difference in the ASES score favoring patients without diabetes. This study found no statistically significant difference in the occurrence of infection between the two groups of patients. Since these studies assessed different outcomes with varying results, the work group found this evidence inconclusive.
One Level IV study73 assessed the effect of medical co-morbidities in patients undergoing open repair of traumatic anterosuperior rotator cuff tears. The authors reported no statistically significant correlation between medical co-morbidities and outcome. They did not provide significance values or define “outcome.” Again, the work group evaluated this as a single study that contained limited evidence. They concluded overall that the evidence is inconclusive concerning the presence of medical co-morbidities and patient outcomes.
There were no studies found that addressed the effects of smoking, prior shoulder infection, or cervical disease as they relate to rotator cuff surgery outcomes.
Although we found no specific evidence demonstrating a significant effect for any of these factors, neither did we find evidence that the above factors had no effect on clinical outcomes after rotator cuff surgery. Therefore, the work group found there to be inconclusive evidence regarding the affects (either positive or negative) of these factors on outcomes after rotator cuff surgery.
Two Level III studies97, 98 compared the outcomes of diabetic and non-diabetic individuals after rotator cuff surgery. One study98 found no statistically significant difference between the two groups on postoperative stiffness using the Constant Murley Score at 46 months. The second study97 found a statistically significant difference and possible clinically important difference in the ASES score favoring patients without diabetes. This study found no statistically significant difference in the occurrence of infection between the two groups of patients. Since these studies assessed different outcomes with varying results, the work group found this evidence inconclusive.
One Level IV study73 assessed the effect of medical co-morbidities in patients undergoing open repair of traumatic anterosuperior rotator cuff tears. The authors reported no statistically significant correlation between medical co-morbidities and outcome. They did not provide significance values or define “outcome.” Again, the work group evaluated this as a single study that contained limited evidence. They concluded overall that the evidence is inconclusive concerning the presence of medical co-morbidities and patient outcomes.
There were no studies found that addressed the effects of smoking, prior shoulder infection, or cervical disease as they relate to rotator cuff surgery outcomes.
Although we found no specific evidence demonstrating a significant effect for any of these factors, neither did we find evidence that the above factors had no effect on clinical outcomes after rotator cuff surgery. Therefore, the work group found there to be inconclusive evidence regarding the affects (either positive or negative) of these factors on outcomes after rotator cuff surgery.
- (73) Namdari S, Henn F, Green A. Traumatic anterosuperior rotator cuff tears: The outcome of open surgical repair. J Bone Joint Surg Am 2008;90(9):1906-1913.
- (97) Chen AL, Shapiro JA, Ahn AK, Zuckerman JD, Cuomo F. Rotator cuff repair in patients with type I diabetes mellitus. J Shoulder Elbow Surg 2003;12(5):416-421.
- (98) Hsu SL, Ko JY, Chen SH, Wu RW, Chou WY, Wang CJ. Surgical results in rotator cuff tears with shoulder stiffness. J Formos Med Assoc 2007;106(6):452-461.