JSES International (Jul 2023)

One-year patient-reported outcomes following primary arthroscopic rotator cuff repair vary little by surgeon

  • Sambit Sahoo, MBBS, PhD,
  • Kathleen A. Derwin, PhD,
  • Yuxuan Jin, MS,
  • Peter B. Imrey, PhD,
  • Eric T. Ricchetti, MD,
  • Vahid Entezari, MD, MMSc,
  • Joseph P. Iannotti, MD, PhD,
  • Kurt P. Spindler, MD,
  • Jason C. Ho, MD,
  • Peter J. Evans,
  • Lutul D. Farrow,
  • Gregory J. Gilot,
  • Anthony A. Miniaci,
  • Mark S. Schickendantz,
  • William H. Seitz,
  • Alfred Serna,
  • Kim L. Stearns,
  • Greg Strnad

Journal volume & issue
Vol. 7, no. 4
pp. 568 – 573

Abstract

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Background: This study’s purpose was to investigate the extent to which differences among operating surgeons may influence 1-year patient-reported outcome measures (PROMs) in patients undergoing rotator cuff repair (RCR) surgery, after controlling for general and disease-specific patient factors. We hypothesized that surgeon would be additionally associated with 1-year PROMs, specifically the baseline to 1-year improvement in Penn Shoulder Score (PSS). Methods: We used mixed multivariable statistical modeling to assess the influence of surgeon (and alternatively surgical case volume) on 1-year PSS improvement in patients undergoing RCR at a single health system in 2018, controlling for eight patient- and six disease-specific preoperative factors as possible confounders. Contributions of predictors to explaining variation in 1-year PSS improvement were measured and compared using Akaike’s Information Criterion. Results: 518 cases performed by 28 surgeons met inclusion criteria, with median (quartiles) baseline PSS of 41.9 (31.9, 53.9) and 1-year PSS improvement of 42 (29.1, 55.3) points. Contrary to expectation, surgeon and surgical case volume were neither statistically significantly nor clinically meaningfully associated with 1-year PSS improvement. Baseline PSS and mental health status (VR-12 MCS) were the dominant and only statistically significant predictors of 1-year PSS improvement, with lower baseline PSS and higher VR-12 MCS predicting larger 1-year PSS improvement. Conclusion: Patients generally reported excellent 1-year outcomes following primary RCR. This study did not find evidence that the individual surgeon or surgeon case volume influences 1-year PROMs, independently of case-mix factors, following primary RCR in a large employed hospital system.

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