Preoperative Patient-Reported Outcomes Predict Postoperative Clinical Outcomes Following Rotator Cuff Repair

Abstract

To determine whether preoperative patient-reported outcomes (PROs) predict postoperative PROs and satisfaction following rotator cuff repair. We retrospectively identified patients who underwent a primary rotator cuff repair at a single institution. A receiver operating characteristics analysis was used to reach a preoperative American Shoulder and Elbow Surgeons (ASES) score threshold predictive of postoperative ASES and satisfaction scores. We evaluated patients above and below the receiver operating characteristics threshold by comparing their final ASES scores, ASES change (Δ) from baseline, percent maximum outcome improvement, and achievement of minimum clinically important differences, substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS). Fischer exact tests were used to analyze categorical data, and continuous data were analyzed using t-test. A total of 348 patients who underwent rotator cuff repair were included in this study. The preoperative ASES value predictive of achieving SCB was 63 (area under the curve, 0.75; 95% confidence interval: 58-67; P < .001). Patients with preoperative ASES less than 63 were significantly more likely to achieve MCID (odds ratio [OR]: 4.7, P < .001) and SCB (OR:6.1, P < .001) and had significantly higher percent maximum outcome improvement (63% vs 41%; P= 0.003) and Δ ASES scores (36 vs 12; P < .001). However, patients with preoperative ASES scores above 63 had significantly higher final ASES scores (86 vs 79; P= .003), were more likely to achieve PASS (59% vs 48%; P= .045), and had higher satisfaction scores (7.4 vs 6.7; P= .024). Patients with high preoperative ASES scores achieve less relative improvement; however,these patients may be more likely to achieve PASS and may have higher satisfaction scores postoperatively. LEVELOF EVIDENCE: Level III, retrospective comparative prognostic trial.