Purpose
The purpose of the current study was to use a nationwide administrative-claims database
to characterize the substance use disorder trends of patients undergoing arthroscopic
rotator cuff repair (RCR). Additionally, we sought to evaluate the influence of preoperative
substance use disorder on postoperative outcomes following arthroscopic RCR.
Methods
The Mariner database was used to identify patients undergoing RCR using CPT codes,
ages 18-84 years old, from 2010 to 2019. Patients were stratified by substance use,
including cannabis, cocaine, nicotine, alcohol, opioids, stimulants, or sedative,
as defined by International Classification of Diseases (ICD) codes. Substance use
disorders trends were reported. Postoperative outcomes assessed consisted of major
complications, minor complications, infections, readmissions, and Emergency Department
visits within 90 days of surgery. Additionally, postoperative stiffness, revision
surgery, and conversion to arthroplasty within 1 year were evaluated. Multivariate
logistic regressions were used to control for demographic and comorbid factors.
Results
Substance use trends from 2010 to 2019 show an increase in documentation of substance
use in patients undergoing RCR. Individuals with a history of substance use disorder
had an increased risk of adverse outcomes, most notably major medical complications
(odds ratio [OR]: 1.63; 95% confidence interval [CI]: 1.44-1.86; P < .001), revision surgery (OR: 1.43; 95% CI: 1.30-1.56; P < .001), and conversion to arthroplasty (OR: 1.40; 95% CI: 1.08-1.80; P = .009). Subgroup analysis demonstrated that cannabis users were at higher risk for
major medical complications (OR: 1.75; 95% CI: 1.15-2.56; P < .001), conversion to arthroplasty (OR: 3.54; 95% CI: 1.77-6.4; P < .001), and revision (OR: 1.53; 95% CI: 1.12-2.04; P < .05) compared to controls. Additionally, substance use was associated with higher
medical costs in terms of procedural cost (β; $3634: $3,490-3,777) and 90-day postoperative
costs (β: $436; $375-$498).
Conclusion
Documentation of substance use disorder is increasing in individuals undergoing arthroscopic
rotator cuff repair. Substance use is associated with higher rates of postoperative
complications, overall costs, and revision surgery following arthroscopic RCR. Nicotine
and cannabis use were most commonly associated with increased rates of postoperative
complications and treatment failure.
Level of Evidence
IV, retrospective therapeutic case series.
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Article info
Publication history
Published online: December 28, 2022
Accepted:
December 13,
2022
Received:
June 14,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
The authors report the following potential conflicts of interest or sources of funding: B.W. reports speaker fees, consulting fees, and research grants from Arthrex; research support from Biomet, Exactech, and Flexion Therapeutics; he is a board or committee member of AAOS, American Orthopaedic Society of Sports Medicine, and American Shoulder and Elbow Surgeons. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 by the Arthroscopy Association of North America
