Worse postoperative outcomes and higher reoperation in smokers compared to nonsmokers for arthroscopic rotator cuff repair

Michael A Gaudiani; Joshua P Castle; Eric X Jiang; Susan G Wager; Spencer R Brown; Johnny K Kasto; Matthew A Gasparro; Alexander S Jurayj; Eric C Makhni; Vasilios Moutzouros; Stephanie J Muh

doi:10.1177/17585732241263834

Worse postoperative outcomes and higher reoperation in smokers compared to nonsmokers for arthroscopic rotator cuff repair

Shoulder Elbow. 2024 Jul 23:17585732241263834. doi: 10.1177/17585732241263834. Online ahead of print.

Affiliations

¹ Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA.
² Wayne State University School of Medicine, Detroit, MI, USA.

Abstract

Background: This study aimed to determine if smokers at the time of arthroscopic rotator cuff repair met the minimally clinical important difference and substantial clinical benefit for Patient-Reported Outcomes Measurement Information System Upper Extremity, Depression, and Pain Interference scores in comparison to nonsmoking patients in a retrospective review.

Methods: Clinical outcomes and Patient-Reported Outcomes Measurement Information System scores were compared between a cohort of nonsmokers and current or former smokers (smokers). Further sub-analysis compared a cohort of nonsmokers propensity-matched 1:1 to a cohort of current/former smokers via age, body mass index, and tear size.

Results: A total of 182 patients, 80 smokers and 102 nonsmokers, were included. Smokers had statistically different-sized tears with more rated massive (P = 0.02) and more reoperations (P = 0.02). Smokers met substantial clinical benefit thresholds at a lower rate than nonsmokers for Patient-Reported Outcomes Measurement Information System Upper Extremity (P = 0.03). In the sub-analysis, 74 smokers were matched to 74 nonsmokers. Smokers had a lower change in Patient-Reported Outcomes Measurement Information System Upper Extremity (P = 0.007) and Patient-Reported Outcomes Measurement Information System Pain Interference (P = 0.03) postoperatively. Fewer smokers met minimally clinical important difference for Patient-Reported Outcomes Measurement Information System Upper Extremity postoperatively (P = 0.003) and more had reoperations (P = 0.02).

Discussion: Overall, smokers demonstrated smaller improvements in function, and pain, and were less likely to meet minimally clinical important differences and substantial clinical benefits for Patient-Reported Outcomes Measurement Information System Upper Extremity at 6 months follow-up when compared to nonsmokers after rotator cuff repair.

Keywords: Patient-Reported Outcomes Measurement Information System; arthroscopic rotator cuff repair; minimally clinical important difference.