Uncovering why female patients have higher disease burden at the time of rotator cuff surgery: sex-based differences in the preoperative period.

Abstract

It is known that sex-based differences exist in the patient population undergoing rotator cuff repair surgery and that female patients have worse postoperative outcomes than their male counterparts, but it is unclear why this difference exists. The purpose of this study was to identify and characterize sex-based differences in preoperative evaluation, management, and disease burden in rotator cuff repair patients. This was a single-center retrospective and cross-sectional study of 100 patients (45 females, 55 males) enrolled preoperatively from January 2022 to January 2023. Median ages of the male and female participants were 59 and 62 years, respectively. Patient self-reported race was 74% White, 22% African American, and 2% Hispanic. The cross-sectional arm included surveying patients to evaluate sex-based differences in the path to orthopedic evaluation and ultimately surgery. The retrospective arm included reviewing patient imaging, preoperative management, timing to surgery, and disease burden. Although resiliency score, pain frequency/intensity, baseline function before injury, and function at the time of survey did not differ between sexes at the time of the first orthopedic evaluation, the preoperative management and disease burden of female patients was different from male patients in multiple ways. Females had a longer time from inciting event to first orthopedic evaluation, trialed nonoperative treatment more often and for a longer duration, had more visits until offered surgery, and had higher Goutallier grade at the time of surgery than males. They additionally had longer time from orthopedic evaluation to magnetic resonance imaging completion and ultimately surgery. Females listed pain and activities of daily living as priorities for scheduling surgery, and males more often had no scheduling barriers. The number, length, and retraction of torn tendon, and type or size of repair (represented by number of anchors and use of single- vs. double-row repair) did not differ between patients. Delayed care in females suffering from rotator cuff pathology is multifaceted, including delay in presentation, later offering of surgery, and higher disease burden. This deficit is crucial to address as females have a higher disease burden at the time of surgery and often have worse outcomes postsurgery.