Neill Y Li1, Steven F DeFroda1, Wesley Durand2, Daniel B C Reid1, Brett D Owens1, Alan H Daniels3. 1. Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, U.S.A.; Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A. 2. Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A. 3. Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, U.S.A.; Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A.. Electronic address: alan_daniels@brown.edu.
Abstract
PURPOSE: To compare postoperative complications, rates of revision, and opioid use of those who undergo shoulder arthroscopy with and without previous anterior cervical discectomy and fusion (ACDF). METHODS: The PearlDiver database from 2007 to 2017 was used to query all patients who underwent shoulder arthroscopy as determined by Current Procedural Terminology (CPT). Patients were then separated among those who had a previous instance of ACDF and those who did not as filtered by CPT. Postoperative complications within 30 days, readmission rates, opioid use, and revision procedures were assessed for each cohort using a mix of International Classification of Diseases Ninth and Tenth Revision Clinical Modification codes, CPT, as well as generic drug codes. RESULTS: A total of 91,029 patients undergoing shoulder arthroscopy were identified, of whom 1,267 (1.4%) had a history of ACDF. Compared with patients without previous ACDF, patients with a history of ACDF had significantly greater respiratory complication rates (1.3% vs 0.5%: adjusted odds ratio [aOR] 2.16, 95% confidence interval [CI]1.30-3.59, P = .003), 30-day complication rates (3.7% vs 2.2%: aOR 1.48, 95% CI 1.10-1.99, P = .011), 1-year revision rates (15.2% vs 7.7%: aOR 2.00, 95% CI 1.71-2.33, P < .0001), and greater opioid use at 1 month, 3 months, 6 months, and 12 months (P < .0001). CONCLUSIONS: This study revealed that patients who undergo shoulder arthroscopy with a history of ACDF are twice as likely to undergo revision arthroscopy within 2 years of surgery and are at an increased risk of complications within 30 days postoperatively as well as prolonged opioid use compared with those without a history of ACDF. With these findings, both spine and shoulder surgeons should aim to be more aware of surgical history, especially of the cervical spine, to better counsel patients' clinical course and expected outcomes following shoulder arthroscopy. LEVEL OF EVIDENCE: III, retrospective cohort study.
PURPOSE: To compare postoperative complications, rates of revision, and opioid use of those who undergo shoulder arthroscopy with and without previous anterior cervical discectomy and fusion (ACDF). METHODS: The PearlDiver database from 2007 to 2017 was used to query all patients who underwent shoulder arthroscopy as determined by Current Procedural Terminology (CPT). Patients were then separated among those who had a previous instance of ACDF and those who did not as filtered by CPT. Postoperative complications within 30 days, readmission rates, opioid use, and revision procedures were assessed for each cohort using a mix of International Classification of Diseases Ninth and Tenth Revision Clinical Modification codes, CPT, as well as generic drug codes. RESULTS: A total of 91,029 patients undergoing shoulder arthroscopy were identified, of whom 1,267 (1.4%) had a history of ACDF. Compared with patients without previous ACDF, patients with a history of ACDF had significantly greater respiratory complication rates (1.3% vs 0.5%: adjusted odds ratio [aOR] 2.16, 95% confidence interval [CI]1.30-3.59, P = .003), 30-day complication rates (3.7% vs 2.2%: aOR 1.48, 95% CI 1.10-1.99, P = .011), 1-year revision rates (15.2% vs 7.7%: aOR 2.00, 95% CI 1.71-2.33, P < .0001), and greater opioid use at 1 month, 3 months, 6 months, and 12 months (P < .0001). CONCLUSIONS: This study revealed that patients who undergo shoulder arthroscopy with a history of ACDF are twice as likely to undergo revision arthroscopy within 2 years of surgery and are at an increased risk of complications within 30 days postoperatively as well as prolonged opioid use compared with those without a history of ACDF. With these findings, both spine and shoulder surgeons should aim to be more aware of surgical history, especially of the cervical spine, to better counsel patients' clinical course and expected outcomes following shoulder arthroscopy. LEVEL OF EVIDENCE: III, retrospective cohort study.
Authors: Berkcan Akpinar; Kinjal Vasavada; Christopher A Colasanti; Michael J Alaia; Eric J Strauss; Laith M Jazrawi Journal: Arthrosc Sports Med Rehabil Date: 2022-06-04