Fowler Kennedy Sport Medicine Clinic, Western University, 3M Centre, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
Faculty of Health Sciences, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
Knee Surg Sports Traumatol Arthrosc. 2020 Feb;28(2):439-447. doi: 10.1007/s00167-019-05638-5. Epub 2019 Jul 29.
To evaluate the longitudinal trends in knee arthroscopy utilization in relation to published negative randomized controlled trials, focusing on annual rates, patient demographics and associated 30-day post-operative complications.
The American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology billing codes to identify arthroscopy cases between 2006 and 2016. 30-day post-operative complications were identified, and potential risk factors analysed using univariate and multivariate analyses.
68,346 patients underwent knee arthroscopy, of which 47,446 (69.5%) represented partial meniscectomies. The annual procedural rate, as a proportion of all reported cases, increased significantly from 2006 (0.3%) to 2016 (1.6%; p < 0.001), along with a significant increase in average patient age (44.3 ± 15.5 to 48.4 ± 14.5; p < 0.001). Specifically focusing on the meniscectomy cohort, average patient age significantly increased from 47.9 ± 15.1 to 50.7 ± 13.5 (p = 0.001). The overall incidence of complications was 2.0% (n = 1333), with major complications in 0.9% (n = 639) and minor complications in 1.0% (n = 701). Common complications included a return to the operating room (0.5%), deep vein thrombosis/thrombophlebitis (0.4%), and superficial infection (0.2%). Operating time > 90 min, diabetes, steroid use, ASA class 2+, and dialysis-dependency were the predictors of overall complication rates.
Despite the publication of negative trials and new clinical practice guidelines, knee arthroscopy utilization and average patient age continue to increase. Given the high utilization, even low adverse event rates equate to substantial numbers of patients with minor and major complications. The NSQIP data show a gap in knowledge translation to clinical practice and highlight the need for improved clinical guidelines.
Cohort study; Level III.
评估膝关节镜检查在与已发表的阴性随机对照试验相关的纵向趋势，重点关注年度使用率、患者特征以及相关的 30 天术后并发症。
使用美国外科医师学会国家手术质量改进计划数据库，通过当前操作术语计费代码，在 2006 年至 2016 年间识别关节镜检查病例。确定 30 天术后并发症，并使用单变量和多变量分析分析潜在的危险因素。
68346 名患者接受了膝关节镜检查，其中 47446 名（69.5%）为部分半月板切除术。手术比例作为所有报告病例的比例，从 2006 年（0.3%）显著增加到 2016 年（1.6%）（p<0.001），同时患者平均年龄也显著增加（44.3±15.5 至 48.4±14.5；p<0.001）。特别关注半月板切除术队列，患者平均年龄从 47.9±15.1 显著增加到 50.7±13.5（p=0.001）。总的并发症发生率为 2.0%（n=1333），其中主要并发症为 0.9%（n=639），次要并发症为 1.0%（n=701）。常见并发症包括返回手术室（0.5%）、深静脉血栓形成/血栓性静脉炎（0.4%）和浅表感染（0.2%）。手术时间>90 分钟、糖尿病、类固醇使用、ASA 分级 2+和透析依赖是总并发症发生率的预测因素。
尽管有负面试验和新的临床实践指南发表，但膝关节镜检查的使用率和患者平均年龄仍在继续增加。鉴于高使用率，即使是低不良事件率也相当于大量出现轻微和严重并发症的患者。NSQIP 数据显示了知识向临床实践转化的差距，并强调了需要改进临床指南。
队列研究；三级。
