Beitragstitel | Development of a prediction model for the occurrence of shoulder stiffness within 6 months after arthroscopic rotator cuff repair |
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Beitragscode | P016 |
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Präsentationsform | Poster |
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Abstract |
Introduction: Arthroscopic rotator cuff repair (ARCR) is a cost-effective procedure associated with rapid recovery of shoulder function and quality of life in most patients. Some patients however experience local complications or do not recover well. Shoulder stiffness which occurs in about 10% of patients within 6 months after ARCR is associated with major limitation in the functional integrity of affected persons in everyday activities. The objective of this project was to develop a predictive model for the risk of occurrence of shoulder stiffness. Methods: Consecutive primary ARCRs documented in a local clinical registry between 10-2013 and 12-2017 were included. We reviewed patient charts retrospectively to identify patients who experienced shoulder stiffness postoperatively until the final clinical follow-up (6 months). Twenty four prognostic factor candidates were considered including patient-related factors (n=4), disease-related factors (n=6), rotator cuff integrity factors (n=7) and operative details (n=7). In a first development step, we used full-case data and logistic regression to develop a predictive model for shoulder stiffness. Predictive accuracy of factors included in the model was assessed by the area under the receiver operating characteristics curve (AUC). Results: We reviewed 1363 ARCR cases (1330 patient CRF) of which 8.2% had shoulder stiffness; full data for all factors were documented in 1000 ARCRs including 87 shoulder stiffness records (8.7%). In final multivariable prognostic model an increased risk of stiffness was associated with partial tears and pre-operation steroid infiltration; the risk was lowered in males, patients with overweight, high baseline passive shoulder flexion (Flex) and abduction (Abd), infraspinatus (ISP) tears, sign of tendon degeneration, and acromioplasty. The AUC was 0.68. Predicted risk of shoulder stiffness ranged from 1.5% to 46%. The highest risk was estimated in a 30-year-old women with no overweight, prior steroid infiltration on a partial tear, baseline Flex and Abd of 170° and 90°, respectively, and no acromioplasty. Conclusion: A prognostic model for postoperative shoulder stiffness was developed for ARCR patients, offering personalized health information to support future decision process for surgery and rehabilitation. Further model validation is required. This offers new possibilities towards the routine use of outcome predictors and risk calculators in shoulder orthopedic surgery. |