Postoperative angiotensin II receptor blocker use is associated with reduced 2-year reoperation rates in male patients undergoing arthroscopic rotator cuff repair

Abstract

Background

Angiotensin II receptor blockers (ARBs) antagonize the effects of transforming growth factor-β1, a cytokine mediator for fibrosis and fatty infiltration in skeletal muscle. The objective of this study was to determine (1) if postoperative ARB use is associated with reduced rates of secondary surgery 2 years following arthroscopic rotator cuff repair, and (2) whether there are differences in these outcomes within male-, female-, and non–sex-specific cohorts.

Methods

The TriNet X national database was queried to identify patients between 2015 and 2022 who were prescribed an ARB (losartan, valsartan, or olmesartan) within 3 months of arthroscopic rotator cuff repair. ARB patients were propensity matched 1:1 with a non-ARB control. Analyses were conducted to assess outcomes differences within male-, female-, and non–sex-specific cohorts. Two-year secondary surgery rates (manipulation under anesthesia, revision rotator cuff repair, conversion to reverse or anatomic total shoulder arthroplasty, and non-rotator cuff repair arthroscopic shoulder procedures) were evaluated and compared using odds ratios (OR).

Results

In total, 2,883 matched ARB and non-ARB rotator cuff repair patients were included, with a mean age of 62.5 years, and 42% female in each cohort. In the non–sex-specific analysis, within 2 years after surgery, the non-ARB cohort had similar rates of revision rotator cuff repair as the control. In the female-specific analysis, 1,228 matched ARB and non-ARB females were included, with an average age of 63.2 years, and there were no statistically significant differences in secondary surgery rates. In the male-specific analysis, 1,562 matched males were included, with an average of 62 years. The male non-ARB cohort reported significantly higher rates of undergoing revision rotator cuff repair (OR 1.33, 95% confidence interval [1.01-1.75], P = .039) and significantly higher rates of undergoing total non–rotator cuff repair arthroscopic shoulder procedures (OR 1.35, 95% [confidence interval] [1.04-1.75], P = .025) compared to the ARB male cohort.

Conclusion

The findings of this study suggest that ARB use may be associated with lower rates of secondary shoulder surgeries in patients undergoing rotator cuff repair, with the effects predominantly observed in male patients.