Comparison of Short-term Complications After Rotator Cuff Repair: Open Versus Arthroscopic

Purpose: To define and compare the incidence and risk factors for short-term complications after arthroscopic and open rotator cuff repair (RTCR), and to identify independent risk factors for complications after RTCR. Methods: All patients who underwent open or arthroscopic RTCR from 2005 to 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Short-term complications were categorized as surgical, medical, mortality, and unplanned 30-day readmission. Univariate analysis allowed the comparison of patient demographics and comorbidities. Propensity score matching was used to control for demographic differences between arthroscopic and open RTCR patient groups. Independent risk factors for complication were identified using multivariate logistic regression. Results: Overall, 11,314 RTCRs were identified (24% open, 76% arthroscopic). The mean operative time for open RTCR was 78 minutes compared with 91 minutes for arthroscopic repairs (P < .001). The overall complication rate was 1.3%, with the highest complication unplanned return to the operating room (41 patients, 0.36%). The 30-day readmission was 1.16% (76/6,560 patients) and the mortality rate was 0.03% (3 patients). Total 30-day complications in the propensity-score-matched patient group were higher after open versus arthroscopic repair (1.79% vs 1.17%; P = .006). The overall infection rate after RTCR was 0.56%, with deep wound infection higher in the open repair patient group (P = .003). Multivariate analysis identified age >65 years (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.2-2.3), operative time >90 minutes (OR 1.5; CI 1.1-2.1), and open RTCR (OR 1.6; CI 1.1-2.3) as independent risk factors for complications. Conclusions: Short-term complications after RTCR are rare. Total complications are higher after open RTCR in propensity-matched patient groups and in multivariate analysis. Risk factors for complications include patient age >65, operative time >90 minutes, and open repair. Open RTCR is associated with an increased risk of surgical infections.