The Influence of Obesity on Outcomes Following Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-Analysis of 118,331 Patients Internationally

Alexis B Sandler; Clare K Green; John P Scanaliato; Austin B Fares; John C Dunn; Nata Parnes

doi:10.2106/JBJS.OA.23.00047

The Influence of Obesity on Outcomes Following Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-Analysis of 118,331 Patients Internationally

JB JS Open Access. 2024 Apr 18;9(2):e23.00047. doi: 10.2106/JBJS.OA.23.00047. eCollection 2024 Apr-Jun.

Authors

Alexis B Sandler^{1

2}, Clare K Green³, John P Scanaliato⁴, Austin B Fares^{1

2}, John C Dunn^{1

2}, Nata Parnes^{5

6}

Affiliations

¹ Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso County, Texas.
² Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas.
³ School of Medicine and Health Sciences, The George Washington University, Washington, DC.
⁴ Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois.
⁵ Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York.
⁶ Department of Orthopaedic Surgery, Claxton-Hepburn Medical Center, Ogdensburg, New York.

Abstract

Background: Given the rising prevalence of obesity, the number of patients with obesity undergoing arthroscopic rotator cuff repair (RCR) will likely increase; however, there have been mixed results in the existing literature with regard to the effect of elevated body mass index (BMI) on functional outcomes and complications.

Methods: The patient-reported outcome measures included the visual analog scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, range of motion, and adverse events.

Results: Fourteen studies (118,331 patients) were included. There were significant decreases in VAS pain scores for both patients with obesity (mean difference, -3.8 [95% confidence interval (CI), -3.9 to -3.7]; p < 0.001) and patients without obesity (mean difference, -3.2 [95% CI, -3.3 to -3.1]; p < 0.001). There were also significant increases in ASES scores for both patients with obesity (mean difference, 24.3 [95% CI, 22.5 to 26.1]; p < 0.001) and patients without obesity (mean difference, 24.3 [95% CI, 21.4 to 26.0]; p < 0.001). There were also significant increases in ASES scores for both patients with obesity (mean difference, 24.3 [95% CI, 22.5 to 26.1]; p < 0.001) and patients without obesity (mean difference, 24.3 [95% CI, 21.4 to 26.0]; p < 0.001). However, there were no significant differences in final VAS pain scores, ASES scores, or range of motion between the groups. The mean rates of complications were higher among patients with obesity (1.2% ± 1.7%) than among patients without obesity (0.59% ± 0.11%) (p < 0.0001), and the mean rates of postoperative admissions were also higher among patients with obesity (5.9%) than patients without obesity (3.7%) (p < 0.0001). Although the mean rates of reoperation were similar between groups (5.2% ± 2.8% compared with 5.2% ± 4.2%), the meta-analysis revealed lower odds of reoperation in patients without obesity (odds ratio [OR], 0.76 [95% CI, 0.71 to 0.82]).

Conclusions: No significant or clinically important differences in postoperative pain, ASES scores, or range of motion were found between patients with and without obesity following arthroscopic RCR. However, populations with obesity had higher rates of complications, postoperative admissions, and reoperation following arthroscopic RCR.

Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.