Effect of Preoperative Hormone Replacement Therapy on Postmenopausal Women Undergoing Rotator Cuff Repair

Background The effect of exogenous estrogen, as hormone replacement therapy (HRT), on surgical outcomes following rotator cuff repair (RCR) is unclear. This study evaluated the effect of preoperative HRT on postmenopausal women undergoing RCR. We hypothesize that preoperative HRT use is associated with higher rates of 90-day complications and worse two-year outcomes after RCR. Methodology A retrospective review of 22,992 female patients undergoing RCR in the PearlDiver database was performed. Patients on HRT within one year preoperatively were matched 1:3 with those not on HRT. Overall, 5,748 on HRT and 17,244 not on HRT were included. Univariate and multivariate analyses were performed to compare outcomes between groups. Results After propensity score matching, HRT patients had higher rates of alcohol disorders (p = 0.008), rheumatologic disorders (p = 0.001), and osteoporosis (p = 0.008), as well as an overall increased comorbidity burden, as shown by an increased Charlson Comorbidity Index score (p < 0.001). At two years postoperatively, the HRT group had increased rates of prolonged opioid use (3,958 (68.9%) vs. 10,527 (61.0%); p < 0.001) and total shoulder arthroplasty (123 (2.1%) vs. 296 (1.7%); p = 0.043). After controlling for the remaining differences between groups, the HRT group was still 40% more likely to have prolonged opioid use at two years post RCR (odds ratio: 1.40, 95% confidence interval: 1.31 to 1.49; p < 0.001). When comparing the type of HRT use, those who used oral HRT had increased rates of prolonged opioid use (3,090 (70.1%) vs. 868 (64.7%); p < 0.001) and total shoulder arthroplasty (104 (2.4%) vs. 19 (1.4%); p = 0.048) at two years postoperatively compared to those who used transdermal HRT. Conclusions Based on this study, preoperative HRT appears safe regarding repair integrity, although surgeons could consider risk stratifying patients based on administration route and implementing multimodal pain management strategies for patients on oral therapies.