June 8, 2015
LYON, France — Results from a prospective study of patients with symptomatic, full-thickness rotator cuff tears highlighted smoking as an independent predictor of poorer patient-reported outcomes.
“We have found that smoking is an independent predictor of outcome for patients with rotator cuff tears,” Bruce S. Miller, MD, said during his presentation at the International Society for Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Biennial Congress. “We found that smokers reported worse pain and lower patient-reported outcome scores at baseline and over the course of 1 year, regardless of whether they had surgical or nonsurgical management.”
Miller and colleagues also found smoking was not significantly associated with treatment allocation for surgical or nonsurgical management, and that surgery diminished the difference in outcome scores within smokers and nonsmokers.
“Smokers who had surgery improved significantly over time, but just not to the extent that nonsmokers did,” Miller said.
To determine the effect of smoking on clinical outcomes of patients treated for symptomatic rotator cuff tears, as well as to examine whether surgeons were biased in their allocation of surgery for the treatment of smokers who presented with these tears, Miller and colleagues studied 196 patients who underwent either conservative or surgical treatment. Overall, 12% of patients were smokers. The only significant demographic difference researchers found between the smoking and nonsmoking groups was age, with smokers being older.
At baseline, smokers reported worse Western Ontario Rotator Cuff (WORC) and American Shoulder and Elbow Surgeons (ASES) scores, as well as higher VAS pain scores. During the 1-year follow-up, WORC, ASES and pain scores remained worse over time for patients who were smokers.
Study results also showed smoking was not associated with treatment allocation. However, the researchers discovered younger patient age and failure to improve symptoms with physical therapy were predictors of surgical allocation.
“What is the clinical significance? Cigarette smoking appears to independently influence the outcome. Thus, these findings could lead to more informed treatment allocations for patients with known tears, and these findings could give clinicians a well-founded opportunity — yet another opportunity — to council patients and recommend smoking cessation,” Miller said. – by Gina Brockenbrough, MA
Reference:
Miller BS, et al. Paper #11. Presented at: International Society for Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Biennial Congress; June 7-11, 2015; Lyon, France.
Disclosure: Miller reports he is a paid consultant for FH Orthopedics.