分析大型私人保险人群中肩袖修复的趋势。
Analysis of rotator cuff repair trends in a large private insurance population.
机构信息
Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA.
出版信息
Arthroscopy. 2013 Apr;29(4):623-9. doi: 10.1016/j.arthro.2012.11.004. Epub 2013 Feb 1.
PURPOSE
The purpose of this study was to identify current trends in open and arthroscopic surgical treatment of rotator cuff tears across sex, age, and region in the United States.
METHODS
Using the PearlDiver Patient Record Database (PearlDiver, Fort Wayne, IN), a publicly available national database of insurance records, patients who underwent rotator cuff repair from 2004 through 2009 were identified. The number of open (CPT codes 23410, 23412, 23420) and arthroscopic (CPT code 29827) rotator cuff repairs were quantified in isolation and in combination with acromioplasty (CPT codes 23415, 29826). The type of procedure, date, sex, and region of the country was identified for each patient. Trend tests (χ(2) and Cochran-Armitage) were used to determine statistical significance.
RESULTS
There were 151,866 rotator cuff repair procedures identified in the database from 2004 through 2009, which represented an incidence of 13.6 for every 1,000 patients assigned an orthopaedic International Classification of Diseases, Ninth Revision (ICD-9) or Current Procedural Terminology (CPT) code. Male patients accounted for 60% of the repairs and female patients for 40%. There were 98,174 arthroscopic cuff repairs (65%) and 53,692 open repairs (35%). The annual percentage of arthroscopic cases increased from 48.8% in 2004 to 74.3% in 2009, whereas the percentage of open cases decreased from 51.2% in 2004 to 25.7% in 2009 (P < .0001). Acromioplasty was also performed in 47.3% of cases, and the rate showed only a slight increase (from 46.6% to 47.8%) between 2004 and 2009 (P < .01). All regions of the United States showed similar surgical trends and trends for sex and age distributions.
CONCLUSIONS
Our analysis shows that the majority of rotator cuff repairs in the United States are now performed arthroscopically (>74%) and there has been a recent steady decline in performance of open rotator cuff repair. Concomitant acromioplasty is performed approximately half the time, and this trend is increasing slightly. These findings were consistent across age, sex, and region in the United States.
LEVEL OF EVIDENCE
IV, cross-sectional study.
目的
本研究旨在确定美国在性别、年龄和地区方面，开放性和关节镜下治疗肩袖撕裂的当前趋势。
方法
使用 PearlDiver 患者记录数据库（PearlDiver，印第安纳州韦恩堡），这是一个公开的全国性保险记录数据库，确定了 2004 年至 2009 年间接受肩袖修复的患者。孤立地和与肩峰成形术（CPT 代码 23415、29826）联合使用时，分别量化了开放性（CPT 代码 23410、23412、23420）和关节镜下（CPT 代码 29827）肩袖修复的数量。为每个患者确定了手术类型、日期、性别和所在国家/地区。使用趋势检验（χ(2)和 Cochran-Armitage）来确定统计学意义。
结果
在 2004 年至 2009 年期间，数据库中确定了 151,866 例肩袖修复手术，每 1,000 名接受骨科国际疾病分类（ICD-9）或当前程序术语（CPT）代码分配的患者中就有 13.6 例。男性患者占修复术的 60%，女性患者占 40%。有 98,174 例关节镜下肩袖修复术（65%）和 53,692 例开放性修复术（35%）。关节镜手术的年度百分比从 2004 年的 48.8%增加到 2009 年的 74.3%，而开放性手术的百分比从 2004 年的 51.2%下降到 2009 年的 25.7%（P<.0001）。肩峰成形术也在 47.3%的病例中进行，且该比例在 2004 年至 2009 年间仅略有增加（从 46.6%增加到 47.8%）（P<.01）。美国所有地区都表现出相似的手术趋势以及性别和年龄分布趋势。
结论
我们的分析表明，美国大多数肩袖修复术现在都是关节镜下进行的（>74%），而开放性肩袖修复术的数量最近稳步下降。同时进行肩峰成形术的比例约为一半，且这一趋势略有增加。这些发现在美国的年龄、性别和地区中均一致。
证据水平
IV，横断面研究。
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