title: Risk factors for readmission and revision surgery following rotator cuff repair.
abstract: Risk factors for revision surgery and hospitalization following rotator cuff repair (RCR) have not been clearly identified. We hypothesized patient factors and surgeon and hospital volume independently contribute to the risk of readmission within 90 days and revision RCR within one year. Using the SPARCS database, we included patients undergoing primary RCR in New York State between 1997 and 2002. These patients were tracked for readmission within 90 days and revision RCR within 1 year. A generalized estimating equation was developed to determine whether patient factors, surgeon volume, or hospital volume were independent risk factors for the above outcome measures. The total annual number of RCR increased from 6,656 in 1997 to 10,128 in 2002. Ambulatory cases increased from 57% to 82% during this time period. Independent risk factors for readmission within 90 days included increasing age and increased number of comorbidities. Independent risk factors for revision RCR included increasing age, increased comorbidity, and lower surgeon volume. Hospital volume had a minimal effect on either outcome measure. The shift toward out-patient surgery mirrors the shift from open to arthroscopic rotator cuff repair. The finding that surgeon volume is a predictor of revision RCR reflects the findings in other orthopaedic procedures.
authors.affiliation: Foster Center for Clinical Outcome Research, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA.
authors.forename: Seth L
authors.initials: SL
authors.lastname: Sherman
authors.forename: Stephen
authors.initials: S
authors.lastname: Lyman
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Koulouvaris
authors.forename: Andrew
authors.initials: A
authors.lastname: Willis
authors.forename: Robert G
authors.initials: RG
authors.lastname: Marx
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D002983:Clinical Competence / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D016017:Odds Ratio; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D017006:Rotator Cuff / Q000601:surgery*; D013997:Time Factors; D017211:Treatment Failure; D016526:Workload / Q000706:statistics & numerical data