Delaying Rotator Cuff Surgery for 12 Months or Longer May Double the Odds of Needing Revision Surgery
Delaying surgery for 12 months or more after a rotator cuff tear diagnosis is associated with almost twice the odds of needing a subsequent revision surgery compared to having surgery between six weeks and one year after diagnosis, according to a retrospective study of records from thousands of patients across the United States by investigators at Hospital for Special Surgery (HSS).
The revision rate for patients with rotator cuff tears who delayed surgery for 12 months or more was 15.2 percent, versus 9.9 percent for those who had surgery within six weeks and 8.3 percent for those who received surgery within the routine period of six weeks to 12 months of diagnosis.
“Patients who have not responded to non-operative approaches for rotator cuff tears frequently ask how long they can delay surgery,” says 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 was published online first on October 1 in the journal Orthopedics.
The rotator cuff is a set of four muscles around the shoulder that keeps the joint centered in order to allow the upper arm to rotate. Rotator cuff tears are common, affecting more than three million people in the United States every year. Most people recover with physical therapy, activity modification, and potentially injections. However, more severe injuries with significant symptoms that continue to affect activities and sleep despite non-surgical approaches require surgical repair. Surgeons typically perform rotator cuff surgery using minimally invasive shoulder arthroscopy. Recovery involves using an arm sling for four to six weeks and several months of rehabilitation.
For their study, the investigators examined de-identified patient records in Humana’s national private-payer insurance claims database. They identified 2,759 patients diagnosed with partial or complete rotator cuff tears who subsequently underwent arthroscopic repair between 2007 and 2016 and grouped them according to the period from diagnosis to initial surgery.
At a minimum follow-up of five years, 1,510 patients (55 percent) had early repair within six weeks, 1,104 patients (40 percent) underwent routine repair between six weeks and 12 months and 145 patients (5.3 percent) received delayed repair more than 12 months after diagnosis.
Overall, the revision surgery rate was 9.6 percent within five years of diagnosis. The differences in revision rates between the delayed repair and both early and routine repair groups were statistically significant. Delayed repair beyond 12 months of diagnosis was associated with an increased risk of undergoing revision surgery compared to 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 says. “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.”
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 11th consecutive year), No. 4 in rheumatology by U.S. News & World Report (2020-2021), and named a leader in pediatric orthopedics by U.S. News & World Report “Best Children’s Hospitals” list (2020-2021). HSS is ranked world #1 in orthopedics by Newsweek (2020-2021). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 130 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.