Coronary Artery Disease and Peripheral Artery Disease Are Associated With Increased Rates of Retear and Postoperative Complications Following Primary Arthroscopic Rotator Cuff Repair.

Abstract

To assess the influence of peripheral artery disease (PAD) and coronary artery disease (CAD) on rotator cuff repair (RCR) outcomes and postoperative complications. A retrospective matched cohort study was conducted using the PearlDiver national insurance claims database. Patients undergoing primary arthroscopic RCR (ARCR) between 2016 and 2020 were identified and stratified into CAD only, PAD only, both CAD and PAD, and control cohorts. A 1:1 matching protocol by age, gender, and tear type was implemented. Patients were further stratified by disease severity based on prior vascular interventions. Primary outcomes included retear rates and revision RCR. Secondary outcomes comprised 90-day postoperative complications. Multivariate logistic regression adjusted for Charlson Comorbidity Index (CCI), age, and gender. Among 358,405 patients undergoing RCR, 45,016 had CAD only, 23,806 had PAD only, and 19,732 had both CAD and PAD. Matched cohorts of CAD only (n = 15,693), PAD only (n = 15,693), both CAD and PAD (n = 15,693), and controls (n = 15,693) demonstrated significantly higher retear rates in CAD only, PAD only, and both CAD and PAD cohorts at 6 months (OR 1.03 vs 1.07 vs 1.04, P = .029), 1 year (OR 1.04 vs 1.09 vs 1.06, P = .003), and 4 years (OR 1.05 vs 1.09 vs 1.08, P < .001). Ninety-day complication rates were also significantly increased across CAD, PAD, and both CAD and PAD groups (OR 6.07 vs 4.06 vs 14.51, P < .001), including ED visits (OR 5.21 vs 3.35 vs 10.81, P < .001), infections (OR 3.98 vs 3.12 vs 9.74, P < .001), acute kidney injury (OR 9.06 vs 3.99 vs 20.10, P < .001), pneumonia (OR 6.11 vs 3.29 vs 13.50, P < .001), pulmonary embolism (OR 18.91 vs 15.27 vs 46.88, P < .001), and sepsis (OR 5.20 vs 3.50 vs 11.85, P < .001). Revision rates trended higher but were not statistically significant at 6 months (OR 0.71 vs 0.91 vs 0.97, P = .57), 1 year (OR 1.22 vs 0.96 vs 1.20, P = .47), or 4 years (1.34 vs 1.07 vs 1.37, P = .08). CAD and PAD significantly increase the risk of rotator cuff retear at 6 months, 1 year, and 4 years in addition to significantly increasing the risk of postoperative complications within 90 days following ARCR. Level III, retrospective comparative case series.