Arthroscopy. 2022 Dec 30;S0749-8063(22)00867-2.doi: 10.1016/j.arthro.2022.12.028. Online ahead of print.

Raisa Masood ¹, Krishna Mandalia ², Michael A Moverman ¹, Richard N Puzzitiello ¹, Nicholas R Pagani ¹, Mariano E Menendez ³, Matthew J Salzler ⁴

Author information

¹Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA.

²Tufts University School of Medicine, Boston, MA.

³Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL.

⁴Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA. Electronic address: msalzler@tuftsmedicalcenter.org.

Abstract

Purpose: To perform a systematic review assessing the relationship between functional somatic syndromes (FSSs) and patient-reported outcome measures (PROMs), post-operative opioid consumption, and hospitalization costs after shoulder and elbow surgery.

Methods: A systematic review of the PubMed and Web of Science databases was conducted according to PRISMA guidelines to identify all studies evaluating the effect of having at least 1 FSS (fibromyalgia, irritable bowel syndrome, chronic headaches, chronic low back pain) on outcomes after shoulder and elbow surgeries. Outcomes of interest included postoperative analgesic use, patient reported outcome measures (PROMs), and hospitalization costs.

Results: The review identified a total of 320 studies, of which 8 studies met the inclusion criteria. The total number of participants in our 8 included studies was 57,389. Three studies (n=620) reported PROMs. These studies demonstrated that the presence of at least one FSS is predictive of significantly higher pain scores and lower quality of recovery, DASH, ASES, and SANE scores postoperatively. Although scores were inferior in among patients with FSS, two of the three studies showed improvement in PROMs in this group of patients. Seven studies (n= 56,909) reported postoperative opioid use. Of these, 5 reported that a diagnosis of at least one FSS was a strong risk factor for long-term opioid use after surgery. One study (n= 480) found that time-driven activity-based costs were significantly higher in patients with FSSs.

Conclusions: Patients with functional somatic syndromes have less favorable PROMs postoperatively, consume more opioids postoperatively, and have higher healthcare costs after elective shoulder and elbow procedures. While PROMs among patients with FSSs are inferior compared to those without FSSs, PROMs still improve compared to baseline.

Level of evidence: Level III, systematic review of Level II-III studies.