Sex Differences Evident in Utilization, Perioperative Outcomes of Arthroscopic Rotator Cuff Repair
Key findings
- This retrospective cohort study analyzed national data on 42,443 adults, 58% male and 42% female, to investigate sex differences in the utilization of arthroscopic rotator cuff repair and several perioperative outcomes between 2010 and 2019
- Total operative time was shorter among women (rate ratio, 0.88), but total length of stay (RR, 1.24) and time from operation to discharge (RR, 1.25) were longer than for men (P<0.001 for all)
- Women exhibited significantly higher odds of minor adverse events within 30 days of surgery (OR, 1.75; P=0.001) but were significantly less likely than men to experience serious adverse events (OR, 0.69; P=0.001) or readmission (OR, 0.80; P=0.025)
- The proportion of procedures performed for women slightly but significantly decreased over the study period, while the length of stay and rates of serious adverse events remained stable
- The factors responsible for sex disparities in arthroscopic rotator cuff repair warrant further investigation
Several studies have found that women undergoing orthopedic surgeries have greater perioperative pain than men and may be at higher risk of chronic postoperative opioid use. Researchers are trying to sort out whether these discrepancies are attributable to biological differences or to physician biases that can result in disparate delivery of care.
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Samuel Rudisill, BS, formerly a sports medicine research assistant in the Department of Orthopaedic Surgery at Massachusetts General Hospital, Scott Martin, MD, director of the Joint Preservation Service at the Hospital, and colleagues recently completed the first study to explore sex differences in arthroscopic rotator cuff repair in a large, nationwide cohort. In JSES International, they report disparities between men and women in perioperative outcomes and utilization of the surgery.
Methods
The researchers used the American College of Surgeons National Surgical Quality Improvement Program database, which contains information from over 700 medical institutions of all types. They identified 42,443 adults, 58% male and 42% female, who underwent primary arthroscopic rotator cuff repair between 2010 and 2019.
Multivariate analyses controlled for age, race, body mass index, ASA class, smoking status, history of chronic obstructive pulmonary disease, and steroid use for chronic conditions.
Perioperative Outcomes
The multivariate analyses showed:
- Total operation time—Rate ratio, 0.88 for women vs. men (P<0.001)
- Total length of hospital stay—RR, 1.24 (P<0.001)
- Days from operation to discharge—RR, 1.25 (P<0.001)
- Readmission rate—OR, 0.80 (P=0.025)
- Rate of serious adverse events within 30 days—OR, 0.69 (P=0.001)
- Rate of minor adverse events within 30 days—OR, 1.75 (P=0.001)
The greater rate of minor adverse effects among women was driven by an increased incidence of urinary tract infection, which may be a consequence of female anatomy and hormones rather than secondary to surgery.
Trends
During the study period, the proportion of arthroscopic rotator cuff repairs performed for women decreased slightly but significantly at an average rate of 0.01% annually (P=0.008). Rates of serious adverse events for men and women remained largely unchanged, and the length of stay was stable.
Clinical Relevance
Clinicians and researchers alike should consider that sex-related disparities in the utilization of arthroscopic rotator cuff repair and perioperative outcomes don't merely reflect baseline demographic or clinical characteristics. Factors underlying these differences deserve more attention.
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