Preoperative testosterone replacement therapy: a potential risk-factor for complications and reoperation after rotator cuff repair.

Background: Prior studies have shown that testosterone replacement therapy (TRT) may be a risk-factor for complications after rotator cuff repair (RCR). This study evaluated complication rates among male RCR patients with and without a history of TRT preoperatively. Methods: A retrospective review of 33,032 male patients undergoing RCR in the PearlDiver database was performed. Patients receiving TRT within 1-year of surgery were propensity score matched 1:3 to those not receiving TRT, 8,258 TRT, and 24,774 no-TRT patients were included. Univariate and multivariate analyses were performed to compare outcomes between groups. Results: After controlling for decreased libido, benign prostatic hypertrophy, tobacco use, alcohol disorders, liver disease, rheumatologic disease, and preoperative steroid injections, TRT patients were more likely to be readmitted within 90 days (odds ratio [OR]: 1.26, P = .013). Within 2 years postoperatively, TRT patients were more likely to undergo (OR: 1.70, P < .001) or revision RCR (OR: 1.53, P < .001) and to have prolonged opioid use (OR: 1.32, P < .001), frozen shoulder (OR: 1.37, P < .001), and stroke/myocardial infarction (OR: 1.20, P < .001). Patients whose last TRT fill was within 6 months prior to surgery had higher rates of 90-day readmission (2.1% vs. 1.3%; P = .048), prolonged opioid use at 2 years (66.6% vs. 62.1%; P = .002), revision RCR at 2 years (13.1% vs. 8.7%; P < .001), and increased 2-year cost ($18,740 vs. $16,006; P < .001) compared to those whose last fill was 6-12 months preoperatively. Conclusion: TRT within 1 year of RCR appears to be a risk factor for multiple postoperative complications and subsequent shoulder surgery. Cessation of TRT prior to RCR should be considered on a patient-specific basis.