Study reveals predictor of shoulder surgery complications

Better management of patients’ blood sugar levels before a common shoulder surgery can lead to improved outcomes, a new study has found.

The research was led by Macquarie University Hospital orthopaedic surgeon Dr Jasan Dannaway, in collaboration with:

• previous shoulder fellow Dr Gaurav Sharma
• academic shoulder and elbow surgeons Associate Professor Sumit Raniga and Professor Desmond Bokor
• statistician Dr Petra Graham.

The research found a link between diabetes control and stiffness after rotator cuff repair.

It looked at 250 people with full thickness postero-superior rotator cuff tears who underwent surgical repair between 2016 and 2018. Patients’ glycated haemoglobin (HbA1c) levels were measured before surgery, which served as a marker for glucose control.

The study found that, six months after surgery, 41 patients had experienced post-operative stiffness. Those with an elevated pre-surgery HbA1c were seven times more likely to have stiffness.

Dr Dannaway says the results show that measuring HbA1c for all patients before this surgery could help identify those at greater risk of stiffness.

“GPs can actively influence this peri-operatively,” he says.

“For those patients with a known history of diabetes, it’s good for us to know how well it is controlled. But we also found a number of patients who didn’t think they had diabetes who actually had diabetes.

“It’s important not to only rely on patient history of diabetes alone.”

Diabetes is a known risk factor for bone and tendon healing and adhesive capsulitis. As rotator cuff disease is the most common cause of shoulder disability in over-50s, and the rate of surgical repair is on the rise, the study results could benefit all patients.

Dr Dannaway says people with poorly controlled diabetes are also at greater risk of infection and poorer general post-surgery outcomes.

“This research adds to the mass of evidence that glycaemic control is important,” he says.

Dr Dannaway received a grant from the US Association for Academic Surgery to present the research at its annual congress in Washington, DC in February this year.

Dr Jasan Dannaway is an orthopaedic surgeon at MQ Health Orthopaedic Services, specialising in shoulder, elbow, wrist and hand surgery.