Trends in Incidence of ACL Reconstruction and Concomitant Procedures Among Commercially Insured Individuals in the United States, 2002-2014.
Trends in Incidence of ACL Reconstruction and Concomitant Procedures Among Commercially Insured Individuals in the United States, 2002-2014.
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DOI：
10.1177/1941738118803616
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发表时间：
2018
期刊：
影响因子：
3.3
通讯作者：
Spang JT
中科院分区：
文献类型：
--
作者：
Herzog MM;Marshall SW;Lund JL;Pate V;Mack CD;Spang JT
很少有关于前交叉韧带（ACL）重建和伴随病理学发生率的基于人群的描述性研究。ACL重建的发生率从2002年到2014年有所增加。描述性临床流行病学研究3级Truven Health Analytics MarketScan Commercial Claims and Encounters数据库包含约1.58亿65岁以下私人投保人的保险登记和医疗保健利用数据，用于获得2002年至2014年期间进行的ACL重建记录以及使用当前程序术语（CPT）和国际疾病分类的任何伴随病理学，第九修订版（ICD-9）编码。分母人群定义为数据库中所有个体的总人年（PY）数。计算总体年发生率，并按年龄、性别和伴随手术分层。从2002年到2014年，有283，810例ACL重建和385，384，623例PY。ACL重建的总体发生率增加了22%，从2002年的61.4/100，000 PY增加到2014年的74.6/100，000 PY。在研究期间，单独ACL重建的发生率相对稳定。然而，在儿童和青少年中，单独ACL重建和ACL重建伴关节手术的比率均大幅增加。13 - 17岁的青少年ACL重建的绝对比率最高，并且在13年的研究期间其比率急剧增加（单独，+37%; ACL +踝关节修复，+107%; ACL +踝关节切除术，+63%）。男性和女性的单独ACL重建率相似（2014年，分别为26.1 vs 25.6/100，000 PY），但男性ACL重建伴关节手术的发生率高于女性。单独ACL重建的发生率和伴随ACL手术的发生率有所增加，特别是在儿童和青少年中。需要重新关注伤害预防计划的采用，以缓解这些趋势。此外，还需要对ACL重建后的长期患者结局和术后医疗保健利用进行更多研究，重点是了解伴随手术中基于性别的差异。
Few population-based descriptive studies on the incidence of anterior cruciate ligament (ACL) reconstruction and concomitant pathology exist. Incidence of ACL reconstruction has increased from 2002 to 2014. Descriptive clinical epidemiology study. Level 3. The Truven Health Analytics MarketScan Commercial Claims and Encounters database, which contains insurance enrollment and health care utilization data for approximately 158 million privately insured individuals younger than 65 years, was used to obtain records of ACL reconstructions performed between 2002 and 2014 and any concomitant pathology using Current Procedures Terminology (CPT) and International Classification of Diseases, Ninth Revision (ICD-9) codes. The denominator population was defined as the total number of person-years (PYs) for all individuals in the database. Annual rates were computed overall and stratified by age, sex, and concomitant procedure. There were 283,810 ACL reconstructions and 385,384,623 PYs from 2002 to 2014. The overall rate of ACL reconstruction increased 22%, from 61.4 per 100,000 PYs in 2002 to 74.6 per 100,000 PYs in 2014. Rates of isolated ACL reconstruction were relatively stable over the study period. However, among children and adolescents, rates of both isolated ACL reconstruction and ACL reconstruction with concomitant meniscal surgery increased substantially. Adolescents aged 13 to 17 years had the highest absolute rates of ACL reconstruction, and their rates increased dramatically over the 13-year study period (isolated, +37%; ACL + meniscal repair, +107%; ACL + meniscectomy, +63%). Rates of isolated ACL reconstruction were similar for males and females (26.1 vs 25.6 per 100,000 PYs, respectively, in 2014), but males had higher rates of ACL reconstruction with concomitant meniscal surgery than females. Incidence rates of isolated ACL reconstruction and rates of concomitant meniscal surgery have increased, particularly among children and adolescents. A renewed focus on adoption of injury prevention programs is needed to mitigate these trends. In addition, more research is needed on long-term patient outcomes and postoperative health care utilization after ACL reconstruction, with a focus on understanding the sex-based disparity in concomitant meniscal surgery.
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