Jourdan M Cancienne1, Stephen F Brockmeier1, Michelle E Kew1, Brian C Werner2. 1. Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A. 2. Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.. Electronic address: bcw4x@virginia.edu.
Abstract
PURPOSE: To examine any association between perioperative serum 25-hydroxyvitamin D levels and failure of arthroscopic rotator cuff repair (RCR) requiring revision surgery. METHODS: Using a private-payer national insurance database, patients who underwent arthroscopic RCR with perioperative serum 25-hydroxyvitamin D levels recorded were included. Patients were stratified into groups of (1) serum 25-hydroxyvitamin D deficiency (<20 ng/mL), (2) insufficiency (20-30 ng/mL), or (3) sufficient (>30-<150 ng/mL). The primary outcome measure was ipsilateral revision rotator cuff surgery, including revision repair, debridement, or reverse shoulder arthroplasty. A multivariable logistic regression analysis was used to control for patient demographics and comorbidities during comparisons. RESULTS: A total of 982 patients were included in the study. The rate of revision rotator cuff surgery was significantly higher in patients in the serum 25-hydroxyvitamin D-deficient group (5.88%) compared with the serum 25-hydroxyvitamin D-sufficient control group (3.7%) (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.6-5.8; P = .007). Patients with serum 25-hydroxyvitamin D deficiency (5.88%) also had a significantly higher incidence of revision surgery compared with patients with serum 25-hydroxyvitamin D insufficiency (OR, 2.4; 95% CI, 1.5-3.9; P = .011). There was no significant difference in the incidence of revision surgery in the serum 25-hydroxyvitamin D-insufficient group (4.97%) compared with the serum 25-hydroxyvitamin D-sufficient control group (3.7%) (OR, 1.4; 95% CI, 0.8-2.3; P = .250). The absolute risk reduction of revision surgery for 25-hydroxyvitamin D-deficient patients compared with controls was 2.2%, corresponding to a number needed to treat to avoid 1 revision surgery of 46 patients, relative risk reduction = 0.59. CONCLUSIONS: Although the present study found a significant statistical association between serum 25-hydroxyvitamin D deficiency and insufficiency and the rate of revision rotator cuff surgery after primary arthroscopic RCR, the absolute differences of these revision rates are minimal and are accompanied with overlapping confidence intervals limiting the clinical significance of these findings. LEVEL OF EVIDENCE: Level III, retrospective cohort study.
PURPOSE: To examine any association between perioperative serum 25-hydroxyvitamin D levels and failure of arthroscopic rotator cuff repair (RCR) requiring revision surgery. METHODS: Using a private-payer national insurance database, patients who underwent arthroscopic RCR with perioperative serum 25-hydroxyvitamin D levels recorded were included. Patients were stratified into groups of (1) serum 25-hydroxyvitamin D deficiency (<20 ng/mL), (2) insufficiency (20-30 ng/mL), or (3) sufficient (>30-<150 ng/mL). The primary outcome measure was ipsilateral revision rotator cuff surgery, including revision repair, debridement, or reverse shoulder arthroplasty. A multivariable logistic regression analysis was used to control for patient demographics and comorbidities during comparisons. RESULTS: A total of 982 patients were included in the study. The rate of revision rotator cuff surgery was significantly higher in patients in the serum 25-hydroxyvitamin D-deficient group (5.88%) compared with the serum 25-hydroxyvitamin D-sufficient control group (3.7%) (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.6-5.8; P = .007). Patients with serum 25-hydroxyvitamin D deficiency (5.88%) also had a significantly higher incidence of revision surgery compared with patients with serum 25-hydroxyvitamin Dinsufficiency (OR, 2.4; 95% CI, 1.5-3.9; P = .011). There was no significant difference in the incidence of revision surgery in the serum 25-hydroxyvitamin D-insufficient group (4.97%) compared with the serum 25-hydroxyvitamin D-sufficient control group (3.7%) (OR, 1.4; 95% CI, 0.8-2.3; P = .250). The absolute risk reduction of revision surgery for 25-hydroxyvitamin D-deficient patients compared with controls was 2.2%, corresponding to a number needed to treat to avoid 1 revision surgery of 46 patients, relative risk reduction = 0.59. CONCLUSIONS: Although the present study found a significant statistical association between serum 25-hydroxyvitamin Ddeficiency and insufficiency and the rate of revision rotator cuff surgery after primary arthroscopic RCR, the absolute differences of these revision rates are minimal and are accompanied with overlapping confidence intervals limiting the clinical significance of these findings. LEVEL OF EVIDENCE: Level III, retrospective cohort study.