Background: The results of preoperative assessment of factors that
might affect the outcome of orthopaedic surgery have rarely been studied. In
this study, we evaluated the relationship between the number of medical
comorbidities and the preoperative performance on outcome assessment tools in
patients with a chronic rotator cuff tear.
Methods: One-hundred and ninety-nine patients (206 shoulders) with a
chronic rotator cuff tear who were treated with surgery were evaluated
preoperatively with a detailed history (including medical comorbidities),
physical examination, and the following outcome instruments: (1) the
Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, (2) the
Simple Shoulder Test, (3) visual analog scales (pain, function, and quality of
life), and (4) the Short Form-36 (SF-36).
Results: The patients had a mean of 2.07 comorbidities (range, zero
to seven comorbidities). With use of univariate regression analysis, a greater
number of comorbidities was associated with worse function (DASH [p = 0.0064],
Simple Shoulder Test [p = 0.0001 for the best-case scenario and p = 0.0009 for
the worst-case scenario], and visual analog scale for function [p = 0.0003]
and increased pain [p = 0.05]) and with worse general health status (physical
function [p < 0.0001], role-physical [p = 0.0286], general health [p <
0.0001], vitality [p = 0.0014], social function [p = 0.0004], role-emotional
[p = 0.0003], and visual analog scale for quality of life [p = 0.0102]). These
results were confirmed with significant associations (p < 0.05) between the
number of comorbidities and the scores on the Simple Shoulder Test; DASH
questionnaire; visual analog scales for function, pain, and quality of life;
and seven of the eight items (all but mental health) on the SF-36 in a
multivariate regression analysis, which included age, gender, Workers'
Compensation status, number of previous operations, smoking history, size of
the tear, duration of symptoms, and average patient expectations as possible
Conclusions: Medical comorbidities have a negative impact on
patient-reported preoperative baseline pain, function, and general health
status associated with chronic rotator cuff tears. We postulate that this
effect may ultimately influence the evaluation of the results of surgical
treatment of rotator cuff tears and should be considered when treating
patients and analyzing outcomes.
Level of Evidence: Prognostic study, Level I-1
(prospective study). See Instructions to Authors for a complete description of
levels of evidence.