Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A..
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A.
Arthroscopy. 2018 Sep;34(9):2677-2682. doi: 10.1016/j.arthro.2018.04.020.
The purpose of this study was to perform a population-level analysis to evaluate the effect of socioeconomic markers on the use of meniscus surgery in patients with meniscus tears.
We queried all hospital-based clinic visits from 2011 to 2014 in the Statewide Planning and Research Cooperative System database, which also contains all New York inpatient/outpatient visits. Patients with known prior knee surgery, meniscus tear before 2011, or other ligament injuries were excluded. The primary outcome was a meniscus procedure (meniscectomy or meniscus repair). Survival analysis was used to calculate the rate of meniscus surgery within 6 months. A multivariate model identified patient factors (age, sex, race, and payer) associated with surgical intervention.
There were 32,012 patients identified who met the inclusion criteria. The rate of meniscus procedure within 6 months of diagnosis was 49.6%. Meniscectomy was performed in 98.8% of cases compared with 1.2% for meniscus repair. Rates of meniscus procedures were higher in patients who were older, male, and white, as well as those first diagnosed by a surgeon. The highest rates of meniscus procedures were in those with private, worker's compensation, or other insurance types. Multivariable analysis showed that female sex, non-white race, and public or self-pay insurance were independently associated with lower rates of meniscus surgery.
These results suggest both insurance-based and race-based disparities regarding surgical treatment. Additionally, the strongest variable for surgical management was a meniscus tear being first diagnosed by a surgeon.
Level of Evidence IV, retrospective case-control study.
本研究旨在进行人群水平分析，以评估社会经济标志物对半月板撕裂患者半月板手术使用的影响。
我们在全州规划和研究合作系统数据库中查询了 2011 年至 2014 年的所有基于医院的就诊记录，该数据库还包含了所有纽约州的住院/门诊就诊记录。排除已知既往膝关节手术、2011 年前半月板撕裂或其他韧带损伤的患者。主要结局是半月板手术（半月板切除术或半月板修复术）。生存分析用于计算 6 个月内半月板手术的比率。多变量模型确定了与手术干预相关的患者因素（年龄、性别、种族和支付者）。
共确定了 32012 名符合纳入标准的患者。诊断后 6 个月内半月板手术的比例为 49.6%。在所有病例中，半月板切除术的比例为 98.8%，而半月板修复术的比例为 1.2%。在年龄较大、男性和白人患者以及由外科医生首次诊断的患者中，半月板手术的比例较高。半月板手术的比例在私人、工人赔偿或其他保险类型的患者中最高。多变量分析显示，女性、非白种人种族和公共或自付保险与半月板手术的比例较低独立相关。
这些结果表明手术治疗存在基于保险和种族的差异。此外，手术管理的最强变量是半月板撕裂首先由外科医生诊断。
IV 级，回顾性病例对照研究。
