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.