Preoperative Substance Use Disorder Is Associated With an Increase in 90-Day Postoperative Complications, 1-Year Revisions and Conversion to Arthroplasty Following Arthroscopic Rotator Cuff Repair: Substance Use Disorder on the Rise

Abstract

The purpose of the current study was to utilize a nationwide administrative-claims database to characterize the substance use disorder trends of patients undergoing arthroscopic RCR. Additionally, we sought to evaluate the influence of preoperative substance use disorder on postoperative outcomes following arthroscopic RCR. The Mariner database was utilized to identify patients undergoing RCR using CPT codes, ages 18-84 years old, from 2010-2019. Patients were stratified by substance use including cannabis, cocaine, nicotine, alcohol, opioids, stimulants, or sedative, as defined by International Classification of Diseases (ICD) codes. Substance use disorders trends were reported. Postoperative outcomes assessed consisted of major complications, minor complications, infections, readmissions, and ED visits within 90-days of surgery. Additionally, postoperative stiffness, revision surgery, and conversion to arthroplasty within 1-year were evaluated. Multivariate logistic regressions were used to control for demographic and comorbid factors. Substance use trends from 2010-2019 show an increase in documentation of substance use in patients undergoing RCR. Individuals with a history of substance use disorder had an increased risk of adverse outcomes, most notably major medical complications(OR 1.63; 95%CI 1.44-1.86; p<0.001), revision surgery(OR 1.43; 95%CI 1.30-1.56, p<0.001), and conversion to arthroplasty(OR 1.40; 95%CI 1.08-1.80, p=0.009). Subgroup analysis demonstrated that cannabis users were at higher risk for major medical complications(OR 1.75; 95%CI 1.15-2.56, p<0.001), conversion to arthroplasty(OR 3.54; 95%CI 1.77-6.4, p<0.001), and revision (OR 1.53; 95%CI 1.12-2.04, p<0.05) compared to controls. Additionally, substance use was associated with higher medical costs in terms of procedural cost(β; $3634: $3,490-3,777) and 90-day postoperative costs(β: $436; $375-$498). Documentation of substance use disorder is increasing in individuals undergoing arthroscopic rotator cuff repair. Substance use is associated with higher rates of postoperative complications, overall costs, and revision surgery following arthroscopic RCR. Nicotine and cannabis use were most commonly associated with increased rates of postoperative complications and treatment failure.