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Original article
Impact of smoking on patient outcomes after arthroscopic rotator cuff repair
  1. Micah Naimark,
  2. Christopher B Robbins,
  3. Joel J Gagnier,
  4. Germanual Landfair,
  5. James Carpenter,
  6. Asheesh Bedi,
  7. Bruce S Miller
  1. Department of Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Micah Naimark; micahnaimark{at}gmail.com

Abstract

Background Cigarette smoking may adversely affect rotator cuff tear pathogenesis and healing. However, the impact of cigarette smoking on outcomes after arthroscopic rotator cuff repair is relatively unknown.

Patients and methods A cohort of 126 patients who underwent arthroscopic rotator cuff repair with minimum 2 years follow-up were retrospectively identified from our institutional database. Patient demographics, comorbidities, and cuff tear index were collected at initial presentation. Outcome measures including American Shoulder and Elbow Surgeons (ASES) score, Western Ontario Rotator Cuff (WORC) score and Visual Analogue Scale (VAS) for pain were collected at each clinical follow-up. Mixed model regression analysis was used to determine the impact of smoking on outcomes, while controlling for tear size and demographics.

Results In our cohort, 14% were active or recent smokers. At baseline, smokers presented with higher pain, greater comorbidities and worse ASES scores than non-smokers. Smokers also had a non-significant trend towards presenting for surgical repair at a younger age and with larger tear sizes. Both smokers and non-smokers had statistical improvements in outcomes at 2 years following repair. Regression analysis revealed that smokers had a worse improvement in ASES but not WORC or VAS pain scores after surgery.

Conclusion The minimal clinically important difference was achieved for ASES, WORC and VAS pain in both smokers and non-smokers, suggesting both groups substantially benefit from arthroscopic rotator cuff repair. Smokers tend to present with larger tears and worse initial outcome scores, and they have a lower functional improvement in response to surgery.

  • rotator cuff repair
  • smoking
  • patient outcomes

This is an Open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjsem-2018-000416

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    Footnotes

    • Contributors Each author had a substantial contribution to the study design, data acquisition, analysis and manuscript composition. All authors have read and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval University of Michigan IRB, Study #: HUM00024612.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data presented in this study is part of a multiple surgeon rotator cuff database with ongoing prospective enrolment at University of Michigan.