Preoperative Nutrition Impacts Retear Rate After Arthroscopic Rotator Cuff Repair.

IF 4.4 1区医学 Q1 ORTHOPEDICS

Journal of Bone and Joint Surgery, American Volume Pub Date : 2024-08-30 DOI:10.2106/JBJS.23.01189

Hitoshi Shitara, Tsuyoshi Ichinose, Tsuyoshi Sasaki, Noritaka Hamano, Masataka Kamiyama, Ryosuke Miyamoto, Fukuhisa Ino, Kurumi Nakase, Akira Honda, Atsushi Yamamoto, Kenji Takagishi, Hirotaka Chikuda

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引用次数: 0

Abstract

Background: A rotator cuff retear following arthroscopic rotator cuff repair (ARCR) is a concern in older patients. However, only a few of its risk factors are amenable to preoperative intervention. We aimed to elucidate the relationship between preoperative nutritional status and rotator cuff retears after ARCR.

Methods: This single-center retrospective study included patients aged ≥65 years with rotator cuff tears who underwent ARCR. The Geriatric Nutritional Risk Index (GNRI) was used to assess preoperative nutritional status. Data collection encompassed patient demographics, clinical assessments, and surgical specifics. Patients were divided into healed and retear groups based on 2-year post-ARCR magnetic resonance imaging results. Logistic regression analysis was conducted to adjust for confounding factors and detect independent risk factors for retears. The GNRI cutoff value for retear prediction was determined by a stratum-specific likelihood ratio; clinical outcomes were compared based on the cutoff values obtained.

Results: Overall, 143 patients were included. The retear rate was 20.3%. The albumin level, GNRI, postoperative shoulder strength of abduction and external rotation, and postoperative Japanese Orthopaedic Association and Constant scores in the retear group were significantly lower than those in the healed group. The logistic regression analysis showed that low risk of morbidity and mortality (compared with no risk) based on the GNRI (odds ratio [OR], 3.39) and medial-lateral tear size per mm (OR = 1.10) were independent risk factors for a retear 2 years after ARCR. Stratum-specific likelihood ratio analysis identified data-driven strata as GNRI < 103, 103 ≤ GNRI < 109, and GNRI ≥ 109. Univariate analysis showed that patients with GNRI < 103 had a significantly higher retear risk than those with 103 ≤ GNRI < 109 and those with GNRI ≥ 109. Logistic regression analysis showed that GNRI < 103 compared with 103 ≤ GNRI < 109 (OR = 3.88) and GNRI < 103 compared with GNRI ≥ 109 (OR = 5.62), along with the medial-lateral tear size per mm (OR = 1.10), were independent risk factors for a retear at 2 years after ARCR.

Conclusions: When assessing the risk of a retear after ARCR, GNRI ≥ 103 may indicate good preoperative nutritional status. However, more data are essential to ascertain the importance of this finding.

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

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术前营养对肩袖关节镜修复术后再撕裂率的影响

背景：关节镜下肩袖修复术（ARCR）后出现肩袖再撕裂是老年患者的一个担忧。然而，只有少数风险因素可以在术前进行干预。我们旨在阐明术前营养状况与 ARCR 术后肩袖撕裂之间的关系：这项单中心回顾性研究纳入了年龄≥65 岁、接受 ARCR 的肩袖撕裂患者。老年营养风险指数（GNRI）用于评估术前营养状况。数据收集包括患者的人口统计学特征、临床评估和手术细节。根据 ARCR 术后两年的磁共振成像结果，将患者分为痊愈组和再撕裂组。进行逻辑回归分析以调整混杂因素并检测再撕裂的独立风险因素。通过分层似然比确定了预测再撕裂的 GNRI 临界值；根据所获得的临界值比较了临床结果：结果：共纳入 143 名患者。再撕裂率为 20.3%。再撕裂组患者的白蛋白水平、GNRI、术后肩关节外展和外旋力量以及术后日本骨科协会和Constant评分均显著低于痊愈组患者。逻辑回归分析表明，根据 GNRI 得出的低发病率和死亡率风险（与无风险相比）（几率比 [OR] 为 3.39）和每毫米内外侧撕裂大小（OR = 1.10）是 ARCR 术后 2 年再撕裂的独立风险因素。分层似然比分析确定数据驱动分层为 GNRI < 103、103 ≤ GNRI < 109 和 GNRI ≥ 109。单变量分析显示，GNRI＜103的患者再撕裂风险明显高于GNRI＜109和GNRI≥109的患者。逻辑回归分析显示，GNRI＜103与103≤GNRI＜109相比（OR=3.88），GNRI＜103与GNRI≥109相比（OR=5.62），以及每毫米内外侧撕裂大小（OR=1.10），是ARCR术后2年发生再撕裂的独立风险因素：结论：在评估 ARCR 术后再次撕裂的风险时，GNRI ≥ 103 可能表明术前营养状况良好。然而，要确定这一结果的重要性，还需要更多的数据：预后III级。有关证据级别的完整描述，请参阅 "作者须知"。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Bone and Joint Surgery, American Volume 医学-外科

CiteScore

8.90

自引率

7.50%

发文量

660

审稿时长

1 months

期刊介绍： The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.