Epidemiology of Anterior Cruciate Ligament Reconstruction Trends, Readmissions, and Subsequent Knee Surgery
Epidemiology of Anterior Cruciate Ligament Reconstruction Trends, Readmissions, and Subsequent Knee Surgery
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DOI：
10.2106/jbjs.h.00539
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发表时间：
2009-10-01
影响因子：
5.3
通讯作者：
Marx, Robert G.
中科院分区：
文献类型：
--
作者：
Lyman, Stephen;Koulouvaris, Panagiotis;Marx, Robert G.
背景：前交叉韧带重建被广泛认为是因前交叉韧带缺陷而导致功能不稳定的个体的首选治疗方法。关于前十字韧带重建的不良后果（例如再次入院和随后的膝关节手术）的流行病学信息仍然很少。我们试图确定前十字韧带重建的频率、后续手术和再入院的发生率以及这些结果的潜在预测因素。方法：利用全州规划和研究合作系统 (SPARCS) 数据库（对纽约州所有入院和门诊手术的普查）来确定 1997 年至 2006 年间进行的前十字韧带重建。包括在内。跟踪患者在手术后九十天内再次入院的情况以及一年内对任一膝盖进行后续手术的情况。使用年龄、性别、合并症、医院和外科医生数量以及住院或门诊手术作为潜在风险因素对这些结果的风险进行建模。结果：我们确定了 70,547 例前交叉韧带重建手术，从 1997 年的 6178 例增加到 2006 年的 7507 例。术后 90 天内再入院的情况很少（发生率为 2.3%），但随后的手术一年内任一膝盖发生这种情况更为常见（发生率 6.5%）。如果患者年龄超过 40 岁、病情较重（例如，有既往合并症）、男性且由手术量较小的外科医生进行手术，则患者在 90 天内再次入院的风险会增加。随后进行膝关节手术的预测因素包括女性、同时进行膝关节手术以及由手术量较小的外科医生进行手术。随后进行前交叉韧带重建的预测因素包括年龄小于 40 岁、同时进行半月板切除术或其他膝关节手术以及在规模较小的医院进行手术。结论：前交叉韧带重建的频率有所增加。此外，虽然前十字韧带重建似乎是一种安全的手术，但对于年轻患者以及接受较少量外科医生或在较小量医院治疗的患者，随后对任一膝盖进行手术的风险会增加。
Background: Anterior cruciate ligament reconstruction is widely accepted as the treatment of choice for individuals with functional instability due to anterior cruciate deficiency. There remains little information on the epidemiology of anterior cruciate ligament reconstruction with regard to adverse outcomes such as hospital readmission and subsequent knee surgery. We sought to identify the frequency of anterior cruciate ligament reconstruction, the rates of subsequent operations and readmissions, and potential predictors of these outcomes.Methods: The Statewide Planning and Research Cooperative System (SPARCS) database, a census of all hospital admissions and ambulatory surgery in New York State, was used to identify anterior cruciate ligament reconstructions performed between 1997 and 2006. Patients with concomitant pathological conditions of the knee were included. The patients were tracked for hospital readmission within ninety days after the surgery and for subsequent surgery on either knee within one year. The risks of these outcomes were modeled with use of age, sex, comorbidity, hospital and surgeon volume, and inpatient or outpatient surgery as potential risk factors.Results: We identified 70,547 anterior cruciate ligament reconstructions, with an increase from 6178 in 1997 to 7507 in 2006. Readmission within ninety days after the surgery was infrequent (a 2.3% rate), but subsequent surgery on either knee within one year was much more common (a 6.5% rate). Patients were at increased risk for readmission within ninety days if they were over forty years of age, sicker (e.g., had a preexisting comorbidity), male, and operated on by a lower-volume surgeon. Predictors of subsequent knee surgery included being female, having concomitant knee surgery, and being operated on by a lower-volume surgeon. Predictors of a subsequent anterior cruciate ligament reconstruction included an age of less than forty years, concomitant meniscectomy or other knee surgery, and surgery in a lower-volume hospital.Conclusions: The rate of anterior cruciate ligament reconstruction has increased in frequency. Also, while anterior cruciate ligament reconstruction appears to be a safe procedure, the risk of a subsequent operation on either knee is increased among younger patients and those treated by a lower-volume surgeon or at a lower-volume hospital.