Increased Perioperative Complication Rates in Patients with Solid Organ Transplants Following Rotator Cuff Repair.

Abstract

BACKGROUND\nRotator cuff repair is the second most common soft-tissue procedure performed in Orthopedics. Additionally, an increasing percentage of the population has received a solid organ transplant (SOT). The chronic use of immunosuppressants as well as a high prevalence of medical comorbidities in this population are both important risk factors when considering surgical intervention. The purpose of this study is to determine the demographic profile, comorbidity profile, and peri-operative complication rate of SOT patients undergoing inpatient rotator cuff repair surgery compared to non-transplanted patients.\n\n\nMETHODS\nThe Nationwide Inpatient Sample (NIS) database was queried from years 2002-2017 to identify all patients who underwent inpatient rotator cuff repair (n=144,528 weighted). This group was further divided into SOT (n=286 weighted) and non-transplant (n=144,242 weighted) cohorts. Demographic and comorbidity analyses was performed between these groups. Additionally, a matched cohort of non-transplanted patients controlled for the year of procedure, age, sex, race, income, and hospital region was created in a 1:1 ratio to the SOT group (n=286 each) for perioperative complication rate analysis.\n\n\nRESULTS\nCompared to non-transplanted patients, SOT patients were more likely to have at least 1 significant medical comorbidity (98% vs. 69%, p < .001), had a higher number of total comorbidities (3.1 vs. 1.4, p < .001), and had a higher Charlson-Deyo Comorbidity Index (2.6 vs. .54, p < .001). Compared to the matched cohort, SOT patients experienced longer hospital stays (2.9 vs. 1.8 days, p < .001), higher surgery costs ($12,031 vs. $8476, p < .001), and were more likely to experience a peri-operative complication (24% vs. 3%, p < .001) with an odds ratio of 7.7 (95% CI: 3.9-15.1).\n\n\nCONCLUSION\nCompared to non-transplanted patients, SOT patients undergoing rotator cuff repair had a significantly higher comorbidity index, longer hospital stays, costlier surgeries, and were over seven times more likely to experience a peri-operative complication. With nearly a quarter of all SOT patients experiencing a perioperative complication following rotator cuff repair, careful consideration for surgery as well as increased postoperative surveillance should be considered in this unique population.\n\n\nLEVEL OF EVIDENCE\nLevel III; Retrospective Cohort Comparison using Large Database; Treatment Study.