Lyman Stephen, Koulouvaris Panagiotis, Sherman Seth, Do Huong, Mandl Lisa A, Marx Robert G
Foster Center for Clinical Outcome Research, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
J Bone Joint Surg Am. 2009 Oct;91(10):2321-8. doi: 10.2106/JBJS.H.00539.
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.
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.
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.
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.
前交叉韧带重建术被广泛认为是治疗因前交叉韧带损伤导致功能不稳定患者的首选方法。关于前交叉韧带重建术不良后果（如再次入院和后续膝关节手术）的流行病学信息仍然很少。我们试图确定前交叉韧带重建术的频率、后续手术和再入院率，以及这些结果的潜在预测因素。
利用全州规划与研究合作系统（SPARCS）数据库，该数据库对纽约州所有住院和门诊手术进行普查，以确定1997年至2006年间进行的前交叉韧带重建术。纳入伴有膝关节病理状况的患者。对患者术后90天内的再次入院情况以及一年内任一膝关节的后续手术情况进行跟踪。以年龄、性别、合并症、医院和外科医生手术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。
我们确定了70547例前交叉韧带重建术，从1997年的6178例增加到2006年的7507例。术后90天内再次入院情况不常见（发生率为2.3%），但一年内任一膝关节的后续手术更为常见（发生率为6.5%）。年龄超过40岁、病情较重（如已有合并症）、男性以及由手术量较少的外科医生进行手术的患者，术后90天内再次入院的风险增加。后续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少的外科医生进行手术。后续前交叉韧带重建术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手术量较少的医院进行手术。
前交叉韧带重建术的频率有所增加。此外，虽然前交叉韧带重建术似乎是一种安全的手术，但年轻患者以及由手术量较少的外科医生或在手术量较少的医院接受治疗的患者，任一膝关节后续手术的风险会增加。
