BACKGROUND: Metabolic disturbances are increasingly recognized as contributing factors in the development of adhesive capsulitis (AC). While metabolic syndrome (MetS) has been established as a risk factor for poorer surgical outcomes, there exist limited data on its impact on postoperative outcomes following surgical treatment for AC. The purpose of this study was to investigate the effects of MetS on complications and costs after surgery for AC.
METHODS: A retrospective cohort analysis from 2011 to 2020 was conducted in the PearlDiver database. Patients with or without MetS who underwent arthroscopic capsular release and/or manipulation under anesthesia for AC were identified using International Classification of Diseases and Current Procedural Terminology diagnosis codes. Patients with active records 1 year prior to and 2 years after the initial diagnosis of AC were eligible. The MetS cohort was matched 1:1 to a control group without MetS based on age, sex, and Charlson Comorbidity Index. Total cost of care at various postoperative time points was compared between cohorts using Student's t-test. Multivariable logistic regression was performed to assess the impact of MetS on 90-day complications and secondary treatment utilization 2 years after surgery. A Bonferroni correction was applied to univariable analyses and multivariable regressions.
RESULTS: The overall prevalence of MetS was 37.5% (n = 16,081) in a cohort of 42,862 patients undergoing AC surgery. After matching, patients with MetS were more likely to experience 90-day hospital readmissions (odds ratio [OR] = 1.89, P < .001), emergency department visits (OR = 1.55, P < .001), and medical complications (OR = 1.10, P < .001), including acute kidney injury (OR = 2.21, P < .001), pulmonary embolism (OR = 2.76, P < .001), myocardial infarction (OR = 1.99, P < .001), urinary tract infection (OR = 1.42, P < .001), and cardiac arrhythmia (OR = 1.51, P < .001). MetS was also associated with higher secondary treatment utilization, including physical therapy (OR = 1.19, P < .001) and intra-articular injections (OR = 1.16, P < .001). Patients with MetS had higher mean costs of care at 60 days ($2,964.1 vs. $2,726.2, P < .001), 90 days ($3,683.2 vs. $3,305.9, P < .001), 1 year ($10,110.6 vs. $7,680.9, P < .001), and 2 years ($19,013.2 vs. $13,577.4, P < .001) after surgery.
CONCLUSION: MetS is associated with increased postoperative complications, secondary treatment utilization, and healthcare costs following surgery for AC. Further prospective studies are required to understand why this relationship exists and to test if targeted management strategies, such as metabolic control and tailored rehabilitation protocols, for this high-risk population can reduce complications and improve outcomes.
