Coronary Artery Disease and Peripheral Artery Disease Are Associated With Increased Rates of Retear and Postoperative Complications Following Primary Arthroscopic Rotator Cuff Repair.

Among patients undergoing rotator cuff repair, substantial proportions had CAD, PAD, or both conditions.

• 358,405 total patients undergoing RCR were identified from the PearlDiver national insurance claims database between 2016 and 2020.
• 45,016 patients had CAD only, 23,806 had PAD only, and 19,732 had both CAD and PAD.
• A 1:1 matching protocol by age, gender, and tear type produced matched cohorts of 15,693 patients in each group (CAD only, PAD only, both CAD and PAD, and controls).
• Multivariate logistic regression adjusted for Charlson Comorbidity Index (CCI), age, and gender.

CAD only, PAD only, and combined CAD and PAD cohorts demonstrated significantly higher retear rates compared to controls at 6 months, 1 year, and 4 years postoperatively.

• At 6 months, retear odds ratios were 1.03 (CAD only) vs 1.07 (PAD only) vs 1.04 (both CAD and PAD), P = .029.
• At 1 year, retear odds ratios were 1.04 (CAD only) vs 1.09 (PAD only) vs 1.06 (both CAD and PAD), P = .003.
• At 4 years, retear odds ratios were 1.05 (CAD only) vs 1.09 (PAD only) vs 1.08 (both CAD and PAD), P < .001.
• PAD only consistently showed the highest retear odds ratios at each time point among the single-disease cohorts.

90-day postoperative complication rates were significantly increased across all vascular disease cohorts compared to controls.

• Overall 90-day complication odds ratios were 6.07 (CAD only) vs 4.06 (PAD only) vs 14.51 (both CAD and PAD), P < .001.
• The combined CAD and PAD group consistently showed the highest odds ratios for all complication types.
• Pulmonary embolism showed the largest effect sizes: OR 18.91 (CAD only) vs 15.27 (PAD only) vs 46.88 (both CAD and PAD), P < .001.
• Acute kidney injury ORs were 9.06 (CAD only) vs 3.99 (PAD only) vs 20.10 (both CAD and PAD), P < .001.
• Emergency department visits ORs were 5.21 (CAD only) vs 3.35 (PAD only) vs 10.81 (both CAD and PAD), P < .001.

Infections, pneumonia, and sepsis were all significantly more common in vascular disease cohorts within 90 days of arthroscopic rotator cuff repair.

• Infection odds ratios were 3.98 (CAD only) vs 3.12 (PAD only) vs 9.74 (both CAD and PAD), P < .001.
• Pneumonia odds ratios were 6.11 (CAD only) vs 3.29 (PAD only) vs 13.50 (both CAD and PAD), P < .001.
• Sepsis odds ratios were 5.20 (CAD only) vs 3.50 (PAD only) vs 11.85 (both CAD and PAD), P < .001.
• All 90-day complications showed a synergistic increase when both CAD and PAD were present together compared to either disease alone.

Revision rotator cuff repair rates trended higher in vascular disease cohorts but did not reach statistical significance at any time point.

• At 6 months, revision RCR odds ratios were 0.71 (CAD only) vs 0.91 (PAD only) vs 0.97 (both CAD and PAD), P = .57.
• At 1 year, revision RCR odds ratios were 1.22 (CAD only) vs 0.96 (PAD only) vs 1.20 (both CAD and PAD), P = .47.
• At 4 years, revision RCR odds ratios were 1.34 (CAD only) vs 1.07 (PAD only) vs 1.37 (both CAD and PAD), P = .08.
• Despite increasing trends over time, none of the revision rate comparisons achieved statistical significance.