A Lengthy Delay in Rotator Cuff Surgery May Increase the Odds of Needing a Revision
Rotator cuff tears are common, affecting more than 3 million people in the US every year. Most patients recover with non-surgical management, but if that fails, surgical repair – typically shoulder arthroscopy – is necessary.
Timing of the surgery is crucial: According to a retrospective study from researchers at Hospital for Special Surgery (HSS), patients who underwent surgery 6 weeks to 12 months after a rotator cuff tear diagnosis had better outcomes than those who delayed surgery for more than 12 months.
In fact, patients who delayed surgery were at a much higher risk for treatment failure and subsequent revision surgery. The revision rate for patients who delayed surgery for more than 12 months was 15.2% in the HSS study, versus 9.9% for those who had surgery within 6 weeks and 8.3% for those who underwent surgery within the routine period of 6 weeks to 12 months after diagnosis.
“Patients who have not responded to non-operative approaches for rotator cuff tears frequently ask how long they can delay surgery,” said Michael C. Fu, MD, MHS, a sports medicine surgeon at HSS and lead author of the study. “Our research was designed to investigate the relationship between delaying surgery and the need for subsequent revision due to failure of the initial rotator cuff repair.” The study has been published online ahead of print by the journal Orthopedics.
For their study, Dr. Fu and his colleagues examined de-identified patient records in Humana’s national private-payer insurance claims database. They identified 2759 patients who were diagnosed with partial or complete rotator cuff tears and who underwent arthroscopic repair between 2007 and 2016.
Patients were grouped according to the period from diagnosis to initial surgery:
- 1510 patients (55%) had early repair within 6 weeks
- 1104 patients (40%) underwent routine repair between 6 weeks and 12 months
- 145 patients (5.3%) had delayed repair of more than 12 months after diagnosis
Overall, the revision surgery rate was 9.6% within 5 years of diagnosis. The differences in revision rates between the delayed repair and both the early and the routine repair groups were statistically significant. Delayed repair beyond 12 months after diagnosis was associated with an increased risk of undergoing revision surgery compared with routine repair, even after controlling for age and other health conditions, with an odds ratio of 1.97 (P=0.009).
“These findings are now informing our discussions with patients about the benefits of surgery and the risks associated with delays,” Dr. Fu said. “Future prospective studies would benefit from including additional data, such as the exact time from rotator cuff injury to surgery, range of motion, imaging results and return to sport outcomes.”
Fu MC, O’Donnell EA, Taylor SA, et al. Delay to arthroscopic rotator cuff repair is associated with increased risk of revision rotator cuff surgery. Orthopedics. 2020 Oct 1:1-5. doi: 10.3928/01477447-20200923-02. Online ahead of print.