Predictors of patient-reported outcomes after primary arthroscopic rotator cuff repair

Abstract

Background: Patient-reported outcomes vary following rotator cuff repair surgery, yet the preoperative factors associated with patient outcomes are not fully understood. This study aimed to assess associations of preoperative patient, disease and surgical factors with 1-year Penn Shoulder Score (PSS) in patients undergoing primary arthroscopic rotator cuff repair (ARCR).

Methods: Patients who underwent ARCR for superior-posterior rotator cuff tendon tears at Cleveland Clinic from February 2015-February 2022 with completed baseline PSS were included. We used multivariable identity-link beta regression and proportional odds models to fit 1-year PSS-Total and subscores to 23 prospectively identified patient, disease, and surgical factors and used R², Nagelkerke's pseudo-R², and incremental changes in Akaike Information Criterion to respectively assess model overall predictive capacities and predictor relative importances, multiply-imputing missing data.

Results: Of 3,483 cases of mean age of 58.8 ± 9.7 (standard deviation) years, 59% were males, 13% current smokers, 24% had chronic pain, 46% had used opioids within the prior year, 32% had at least one psychiatric diagnosis, and 5% had Worker's Compensation insurance. Median (quartiles) preoperative Veterans Rand 12-Item Health Survey Mental Component Score (VR-12-MCS) and PSS were 53.2 (43.9, 60.5) and 40.0 (29.5, 52.0), respectively. 1-year PSS was provided by 2,491 patients (72%) with median 90.0 (76.0, 97.0) reflecting significant improvement. Lower preoperative PSS, VR-12-MCS, and nonprivate insurance (particularly Workmen's Compensation) were the most important predictors of lower 1-year PSS and all subscores. Other (neither White nor Black) self-reported race, a chronic pain diagnosis, glenohumeral cartilage degeneration, and no acromioplasty were also statistically significantly associated with lower 1-year PSS. Model R² was 20%. Sensitivity analyses showed that inclusion of preoperative PSS and VR-12-MCS as predictors suppressed the statistical significance of several other patient factors.

Conclusion: Patients generally reported excellent 1-year outcomes following primary ARCR. The most important predictors of 1-year PSS were baseline PSS, VR-12-MCS, and insurance type, with race and acromioplasty also among top predictors. However, the 23 factors examined in this study only account for a modest fraction of the variability in 1-year PSS, suggesting that other factors, for example, strength, structural healing, and patient biology, may contribute as well.

Keywords: PENN shoulder score; PROMs; Shoulder; beta regression; multivariable model; predictors; preoperative factors; rotator cuff repair.