Hyperlipidemia Is Associated With an Increased Risk of Secondary Procedures in Patients Undergoing Arthroscopic Rotator Cuff Repair.

INTRODUCTION: Hyperlipidemia (HLD) has been implicated as a risk factor for impaired tendon-to-bone healing after arthroscopic rotator cuff repair (RCR). While statin therapy may mitigate this effect, findings remain inconsistent. We hypothesized that HLD would be associated with higher rates of secondary procedures following RCR and that perioperative statin therapy could reduce this risk. METHODS: A retrospective cohort study was conducted using the TriNetX Research Network, a federated database of over 120 million de-identified patient records. Adults undergoing primary arthroscopic RCR (CPT 29827) between October 2015 and August 2020 were identified. Patients were grouped as (1) no HLD, (2) HLD without statin use, and (3) HLD with perioperative statin use (prescription within 90 days before or after surgery). Outcomes included repeat RCR and arthroplasty at 6 months, 1, 3, and 5 years. Propensity score matching (1:1 nearest neighbor, caliper 0.1) was performed on demographics, comorbidities, and surgical factors. Odds ratios (RR) with 95% confidence intervals (CI) and Kaplan-Meier analyses were used with significance set at p < 0.05. LEVEL OF EVIDENCE: Level III, Retrospective Cohort Comparison using Large Database, Prognosis Study RESULTS: After matching, 40,430 patients were included per group. At 5 years, repeat repair occurred in 9.8% of patients with hyperlipidemia compared to 7.0% of controls (p < 0.001, OR = 1.440 (1.370-1.514)). Hyperlipidemia was associated with increased odds of arthroplasty at 3 years (1.1% vs. 1.0%, p = 0.024, OR = 1.169 (1.020 - 1.340)) and 5 years (1.5% vs. 1.2%, p < 0.001, OR = 1.312 (1.162 - 1.481)). Sub-analyses by total cholesterol and LDL levels did not show a consistent relationship between lipid level and reoperation risk. Statin therapy did not reduce reoperation risk and was associated with higher rates of repeat RCR and arthroplasty among patients with low cholesterol. CONCLUSION: HLD was associated with modestly higher rates of secondary procedures following arthroscopic RCR, while lipid levels and statin therapy were not predictive of reduced reoperation, highlighting the complex role of lipid metabolism in tendon healing.