Association between in-hospital nursing workload and early functional recovery after unilateral arthroscopic rotator cuff repair: a retrospective cohort study

Background Early functional recovery after arthroscopic rotator cuff repair (ARCR) varies substantially among patients. Although surgical characteristics and rehabilitation strategies have been widely investigated, few studies have examined patient-level early postoperative nursing workload as an integrated indicator of care complexity after ARCR. Methods This single-center retrospective cohort study included 202 patients who underwent unilateral ARCR between January 2022 and December 2024. Patient-level nursing workload within the first 48 hours postoperatively (NWI-48h) was quantified using structured nursing records. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score at 3 months. Multivariable linear regression and logistic regression analyses were performed with progressive adjustment for potential confounders. Results Higher NWI-48h was associated with lower ASES scores at 3 months. In the fully adjusted model, each 1-SD increase in NWI-48h was associated with a 4.21-point decrease in ASES score (95% CI, −7.04 to −1.38; P = 0.004). Patients in the high-workload group had lower 3-month ASES scores than those in the low-workload group, with a graded association across workload tertiles. For unplanned healthcare visits or hospital readmissions, adjusted estimates were imprecise, with wide confidence intervals, and should be regarded as hypothesis-generating. Conclusion Higher early postoperative patient-level nursing workload was associated with poorer short-term functional recovery after unilateral ARCR. NWI-48h may serve as a candidate indicator of early postoperative care complexity that warrants prospective validation before clinical application.