Alcohol Use Disorder Is Associated With Higher Rates of Adverse Events, Readmissions, and Costs of Care Within 90 Days of Arthroscopic Rotator Cuff Repair.

PURPOSE: To determine whether alcohol use disorder (AUD) patients undergoing arthroscopic rotator cuff repair (ARCR) have higher rates of (1) medical complications, (2) readmission rates, and (3) costs of care.

METHODS: A retrospective review of a private insurance payor was performed. All patients who underwent ARCR were initially identified as the base population. All patients with a diagnosis of AUD were filtered from this base population and served as the study cohort. Conversely, those patients without AUD who underwent ARCR represented the comparison cohort. Patients who underwent ARCR were then matched to those patients who underwent ARCR with a diagnosis of AUD in 1:5 ratio with respect to age, sex, and comorbidities. Primary end points of this study included 90-day medical complications, 90-day readmission rates, in addition to the day of surgery, and total global 90-day episode of care costs. Ninety-day medical complications analyzed included cerebrovascular accidents, deep vein thromboses, myocardial infarctions, pneumonia, pulmonary emboli, surgical site infections, urinary tract infections, and venous thromboemboli. Statistical analyses were performed using the programming language R (R Foundation for Statistical Computing, Vienna, Austria). Age, sex, and medical comorbidities of the matched cohorts were compared using Pearson's χ2 analyses. Logistic regression analyses were used to calculate odds ratios (OR) and 95% confidence intervals on the effects of AUD on 90-day medical complications and 90-day readmissions. Descriptive analyses were performed for the 90-day causes of readmissions after the index procedure.

RESULTS: The query yielded 140,886 patients within the study (n = 23,484) and comparison (n = 117,402) cohort. AUD patients were found to have a higher frequency and odds of developing adverse events within 90 days after the index procedure (19.03% vs 3.38%; OR: 6.47; P < .0001). Study group patients were found to have higher rates and odds of developing pneumonia (6.14% vs 0.71%; OR: 9.08; P < .0001), cerebrovascular accidents (1.78% vs 0.25%; OR: 7.17; P < .0001), and myocardial infarctions (0.91% vs 0.15%; OR: 6.02; P < .0001) among other complications. AUD was associated with significantly higher incidence and odds of 90-day readmissions after ARCR (2.05% vs 1.13%; OR: 1.83; P < .0001). The investigation showed that study group patients were found to have significantly higher rates of 90-day episode of care costs ($4807.06 vs $4431.31).

CONCLUSIONS: This investigation shows that in patients undergoing ARCR, AUD is associated with higher rates of pneumonia, cerebrovascular accidents, myocardial infarctions, urinary tract infections, deep vein thromboses, surgical site infections, venous thromboemboli, pulmonary emboli, readmission rates, and costs of care.

LEVEL OF EVIDENCE: Level III, prognostic retrospective comparative case series.