Basques Bryce A, Gardner Elizabeth C, Varthi Arya G, Fu Michael C, Bohl Daniel D, Golinvaux Nicholas S, Grauer Jonathan N
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
Am J Sports Med. 2015 Jan;43(1):169-75. doi: 10.1177/0363546514551923. Epub 2014 Oct 7.
Recent studies have questioned the efficacy of meniscectomy in older patients with and without evidence of osteoarthritis; however, it continues to be frequently performed. There is limited information about age and other risk factors for adverse events and readmission after the procedure. This knowledge is vital to understand the true risk profile of this common surgery.
To investigate if age and medical comorbidities were risk factors for postoperative adverse events and readmission after meniscectomy.
Case-control study; Level of evidence, 3.
Patients who underwent arthroscopic meniscectomy between 2005 and 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Age≥65 years and medical comorbidities were evaluated as risk factors for any adverse event (AAE), severe adverse events (SAEs), and readmission after meniscectomy using univariate and multivariate analyses.
A total of 17,774 patients who underwent meniscectomy were identified. The mean age was 53.0±13.6 years. A total of 3420 patients (19.2%) were ≥65 years. Overall, 208 patients (1.17%) had AAE, 203 patients (1.14%) had an SAE, and 102 patients were readmitted (0.97%). Multivariate logistic regression analyses demonstrated no significant differences between age groups for the occurrence of AAE, SAEs, and readmission. Patients with American Society of Anesthesiologists classification≥3 had increased odds of AAE (odds ratio [OR], 1.58), SAEs (OR, 1.59), and readmission (OR, 1.99). Patients with diabetes had increased odds of AAE (OR, 1.57) and SAEs (OR, 1.51). Smokers had increased odds of readmission (OR, 1.67). Patients with pulmonary disease had increased odds of AAE (OR, 1.76) and SAEs (OR, 1.70).
Meniscectomy is a safe procedure in older patients, as age over 65 years did not increase the odds of any of the adverse events studied. However, regardless of age, patients with an increased comorbidity burden and those with a history of smoking are at increased risk of adverse events and/or readmission after the procedure.
Knowledge of these risk factors for adverse events and readmission provides essential information for patient selection and preoperative counseling.
近期研究对半月板切除术在有或无骨关节炎证据的老年患者中的疗效提出了质疑；然而，该手术仍经常被实施。关于该手术后不良事件和再入院的年龄及其他风险因素的信息有限。了解这些知识对于理解这种常见手术的真实风险状况至关重要。
探讨年龄和内科合并症是否为半月板切除术后不良事件和再入院的风险因素。
病例对照研究；证据等级：3级。
从美国外科医师学会国家外科质量改进计划（ACS NSQIP）数据库中识别出2005年至2012年间接受关节镜下半月板切除术的患者。使用单因素和多因素分析，将年龄≥65岁和内科合并症评估为半月板切除术后任何不良事件（AAE）、严重不良事件（SAE）和再入院的风险因素。
共识别出17774例接受半月板切除术的患者。平均年龄为53.0±13.6岁。共有3420例患者（19.2%）年龄≥65岁。总体而言，208例患者（1.17%）发生了AAE，203例患者（1.14%）发生了SAE，102例患者再次入院（0.97%）。多因素逻辑回归分析表明，各年龄组在AAE、SAE的发生及再入院方面无显著差异。美国麻醉医师协会分级≥3级的患者发生AAE（优势比[OR]，1.58）、SAE（OR，1.59）和再入院（OR，1.99）的几率增加。糖尿病患者发生AAE（OR，1.57）和SAE（OR，1.51）的几率增加。吸烟者再入院的几率增加（OR，1.67）。肺部疾病患者发生AAE（OR，1.76）和SAE（OR，1.70）的几率增加。
半月板切除术对老年患者是一种安全的手术，因为65岁以上的年龄并未增加所研究的任何不良事件的发生几率。然而，无论年龄如何，合并症负担增加的患者以及有吸烟史的患者术后发生不良事件和/或再入院的风险增加。
了解这些不良事件和再入院的风险因素为患者选择和术前咨询提供了重要信息。
