Impact of Smoking on Patient Reported Outcome Measures Following Arthroscopic Rotator Cuff Repair: A 2-Year Comparative Cohort Study

Abstract Background Smoking is a well-established risk factor for tendon healing. Hypothesis/Purpose The purpose of this study was to evaluate the differences in patient-reported outcome measures (PROMs) between smokers and non-smokers who have undergone arthroscopic rotator cuff repair (RCR). It was hypothesized that smokers would have worse self-reported outcomes at 1- and 2-years postoperatively. Methods 560 consecutive patients who underwent arthroscopic RCR were divided into two groups: Group I (smokers) n=25 and Group II (non-smokers) n=535. All participants were administered preoperative and postoperative surveys consisting of the following outcome-measuring tools: (i) VAS, (ii) VR-12, (iii) ASES, (iv) standard preoperative form consisting of four questions regarding their expectations of recovery, (v) SANE shoulder score, and (vi) STT. Results At 1- and 2-years postoperative, non-smokers reported statistically significant differences in VR-12 mental scores (respectively: 56.2 vs 51.9, p = 0.0162 and 56.3 vs 49.5, p = 0.0004). ASES scores showed no differences until the 2-year mark, at which time non-smokers reported higher scores than smokers (87.9 vs 79.0, p = 0.0212). SANE scores also remained similar up until 2-year follow-up at which time non-smokers reported statistically significant improvement (80.0 vs 68.5, p = 0.0339). Non-smokers reported higher SST Scores at baseline and at 2-year follow-up (respectively: 43.3 vs 37.0, p = 0.0417 and 83.7 vs 68.1, p = 0.0046). Conclusion At 2-years postoperatively, non-smokers had significantly higher PROM scores than smokers. In elective surgery, smoking status should be considered as a risk factor for poorer patient reported outcomes following arthroscopic RCR. However, smokers continue to report a clinical benefit at 2-years postoperatively.