Do patients who smoke tobacco have success with primary arthroscopic rotator cuff repair? A comparison with nonsmokers

Background: It is recommended that patients cease smoking before rotator cuff repair. However, not all patients want to or are able to successfully cease smoking. This raises the question if these patients should be advised to pursue surgical intervention or if surgery should be contraindicated until patients successfully cease smoking. Methods: A retrospective analysis of patients undergoing rotator cuff repair was performed to examine the effects of smoking tobacco on patient-determined outcomes (Western Ontario Rotator Cuff Index [WORC], American Shoulder and Elbow Surgeons score [ASES], Simple Shoulder Test [SST], and Single Assessment Numeric Evaluation [SANE]). Patients who smoked tobacco at the time of surgery were compared with patients who were not smoking to determine if differences in (1) severity of preoperative and postoperative symptoms and (2) the postoperative improvements were statistically significant. Results: Thirty-one patients were smokers and 205 were nonsmokers. Preoperative scores were worse for smokers compared with nonsmokers: WORC (32 vs. 43; P=.0002), ASES (32 vs. 43; P=001), SST (3.5 vs. 4.6; P=.04), and SANE (34 vs. 38; P=.35). Postoperative scores were worse for smokers compared with nonsmokers: WORC (79 vs. 89; P=.001), ASES (82 vs. 89; P=.04), SST (9.0 vs. 10.2; P=.02), and SANE (84 vs. 89; P=.09). There were no significant differences in change in scores over time or percentage of patients achieving the minimal clinically important difference of the score between groups. Conclusions: From examining the patients' subjective patient-determined outcome scores, it does not appear that rotator cuff repair should be strictly contraindicated in active smokers. Postoperative improvements in smokers were similar to nonsmokers. Smokers have lower baseline preoperative and postoperative outcome scores compared with nonsmokers. (C) 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.