Clinical Orthopaedics and Related Research

, Volume 466, Issue 3, pp 608–613 | Cite as

Risk Factors for Readmission and Revision Surgery Following Rotator Cuff Repair

  • Seth L. Sherman
  • Stephen LymanEmail author
  • Panagiotis Koulouvaris
  • Andrew Willis
  • Robert G. Marx
Symposium: New Approaches to Shoulder Surgery


Risk factors for revision surgery and hospitalization following rotator cuff repair (RCR) have not been clearly identified. We hypothesized patient factors and surgeon and hospital volume independently contribute to the risk of readmission within 90 days and revision RCR within one year. Using the SPARCS database, we included patients undergoing primary RCR in New York State between 1997 and 2002. These patients were tracked for readmission within 90 days and revision RCR within 1 year. A generalized estimating equation was developed to determine whether patient factors, surgeon volume, or hospital volume were independent risk factors for the above outcome measures. The total annual number of RCR increased from 6,656 in 1997 to 10,128 in 2002. Ambulatory cases increased from 57% to 82% during this time period. Independent risk factors for readmission within 90 days included increasing age and increased number of comorbidities. Independent risk factors for revision RCR included increasing age, increased comorbidity, and lower surgeon volume. Hospital volume had a minimal effect on either outcome measure. The shift toward out-patient surgery mirrors the shift from open to arthroscopic rotator cuff repair. The finding that surgeon volume is a predictor of revision RCR reflects the findings in other orthopaedic procedures.

Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.


Rotator Cuff Readmission Rate Hospital Volume Rotator Cuff Repair Total Annual Number 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Samuel Chu for assistance with manuscript preparation.


  1. 1.
    Bartolozzi A, Andreychik D, Ahmad S. Determinants of outcome in the treatment of rotator cuff disease. Clin Orthop Relat Res. 1994;308:90–97.PubMedGoogle Scholar
  2. 2.
    Cofield RH. Rotator cuff disease of the shoulder. J Bone Joint Surg Am. 1985;67:974–979.PubMedGoogle Scholar
  3. 3.
    Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol, 1992;45:613–619.PubMedCrossRefGoogle Scholar
  4. 4.
    Duckworth DG, Smith KL, Campbell B, Matsen FA. 3rd. Self-assessment questionnaires document substantial variability in the clinical expression of rotator cuff tears. J Shoulder Elbow Surg. 1999;8:330–333.PubMedCrossRefGoogle Scholar
  5. 5.
    Dunn WR, Schackman BR, Walsh C, Lyman S, Jones EC, Warren RF, Marx RG. Variation in orthopaedic surgeons’ perceptions about the indications for rotator cuff surgery. J Bone Joint Surg Am. 2005;87:1978–1984.PubMedCrossRefGoogle Scholar
  6. 6.
    Farley DE, Ozminkowski RJ. Volume-outcome relationships and in-hospital mortality: the effect of changes in volume over time. Med Care. 1992;30:77–94.PubMedCrossRefGoogle Scholar
  7. 7.
    Gazielly DF, Gleyze P, Montagnon C. Functional and anatomical results after rotator cuff repair. Clin Orthop Relat Res. 1994;304:43–53.PubMedGoogle Scholar
  8. 8.
    Gibbs BF, Guzzetta VJ, Furmanski D. Cost-effective carotid endarterectomy in community practice. Ann Vasc Surg. 1995;9:423–427.PubMedCrossRefGoogle Scholar
  9. 9.
    Green LB, Pietrobon R, Paxton E, Higgins LD, Fithian D. Sources of variation in readmission rates, length of stay, and operative time associated with rotator cuff surgery. J Bone Joint Surg Am. 2003;85:1784–1789.PubMedGoogle Scholar
  10. 10.
    Hammond JW, Queale WS, Kim TK, McFarland EG. Surgeon experience and clinical and economic outcomes for shoulder arthroplasty. J Bone Joint Surg Am. 2003;85:2318–2324.PubMedGoogle Scholar
  11. 11.
    Harryman DT 2nd, Hettrich CM, Smith KL, Campbell B, Sidles JA, Matsen FA. 3rd. A prospective multipractice investigation of patients with full-thickness rotator cuff tears: The importance of comorbidities, practice, and other covariables on self-assessed shoulder function and health status. J Bone Joint Surg Am. 2003;85:690–696.PubMedGoogle Scholar
  12. 12.
    Harryman DT 2nd, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA 3rd. Repairs of the rotator cuff. correlation of functional results with integrity of the cuff. J Bone Joint Surg Am. 1991;73:982–989.PubMedGoogle Scholar
  13. 13.
    Jain N, Pietrobon R, Hocker S, Guller U, Shankar A, Higgins LD. The relationship between surgeon and hospital volume and outcomes for shoulder arthroplasty. J Bone Joint Surg Am. 2004;86:496–505.PubMedCrossRefGoogle Scholar
  14. 14.
    Jain NB, Pietrobon R, Guller U, Ahluwalia AS, Higgins LD. Influence of provider volume on length of stay, operating room time, and discharge status for rotator cuff repair. J Shoulder Elbow Surg. 2005;14:407–413.PubMedCrossRefGoogle Scholar
  15. 15.
    Katz JN, Losina E, Barrett J, Phillips CB, Mahomed NN, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States Medicare population. J Bone Joint Surg Am. 2001;83:1622–1629.PubMedCrossRefGoogle Scholar
  16. 16.
    Lavernia CJ, Guzman JF. Relationship of surgical volume to short-term mortality, morbidity, and hospital charges in arthroplasty. J Arthroplasty. 1995;10:133–140.PubMedCrossRefGoogle Scholar
  17. 17.
    Lester DK, Linn LS. Variation in hospital charges for total joint arthroplasty: an investigation of physician efficiency. Orthopedics. 2000;23:137–140.PubMedGoogle Scholar
  18. 18.
    McMahon LF Jr, Newbold R. Variation in resource use within diagnosis-related groups: the effect of severity of illness and physician practice. Med Care. 1986;24:388–397.PubMedCrossRefGoogle Scholar
  19. 19.
    Rozencwaig R, van Noort A, Moskal MJ, Smith KL, Sidles JA, Matsen FA 3rd. The correlation of comorbidity with function of the shoulder and health status of patients who have glenohumeral degenerative joint disease. J Bone Joint Surg Am. 1998;80:1146–1153.PubMedGoogle Scholar
  20. 20.
    Skutek M, Fremerey RW, Zeichen J, Bosch U. Outcome analysis following open rotator cuff repair: early effectiveness validated using four different shoulder assessment scales. Arch Orthop Trauma Surg. 2000;120:432–436.PubMedCrossRefGoogle Scholar
  21. 21.
    Tashjian RZ, Henn RF, Kang L, Green A. The effect of comorbidity on self-assessed function in patients with a chronic rotator cuff tear. J Bone Joint Surg Am. 2004;86:355–362.PubMedGoogle Scholar
  22. 22.
    Taylor HD, Dennis DA, Crane HS. Relationship between mortality rates and hospital patient volume for Medicare patients undergoing major orthopaedic surgery of the hip, knee, spine, and femur. J Arthroplasty. 1997;12:235–242.PubMedCrossRefGoogle Scholar
  23. 23.
    Vitale MG, Krant JJ, Gelijns AC, Heitjan DF, Arons RR, Bigliani LU, Flatow EL. Geographic variations in the rates of operative procedures involving the shoulder, including total shoulder replacement, humeral head replacement, and rotator cuff repair. J Bone Joint Surg Am. 1999;81:763–772.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Seth L. Sherman
    • 1
  • Stephen Lyman
    • 1
    Email author
  • Panagiotis Koulouvaris
    • 1
  • Andrew Willis
    • 1
  • Robert G. Marx
    • 1
  1. 1.Foster Center for Clinical Outcome ResearchHospital for Special SurgeryNew YorkUSA

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