Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Harbor City, California.
Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California.
J Bone Joint Surg Am. 2019 Sep 4;101(17):1546-1553. doi: 10.2106/JBJS.18.01408.
There have been few large studies involving multiethnic cohorts of patients treated with anterior cruciate ligament reconstruction (ACLR), and therefore, little is known about the role that race/ethnicity may play in the differential risk of undergoing revision surgery following primary ACLR. The purpose of this study was to evaluate whether differences exist by race/ethnicity in the risk of undergoing the elective procedure of aseptic revision in a universally insured cohort of patients who had undergone ACLR.
This was a retrospective cohort study conducted using our integrated health-care system's ACLR registry and including primary ACLRs from 2008 to 2015. Race/ethnicity was categorized into the following 4 groups: non-Hispanic white, black, Hispanic, and Asian. Multivariable Cox proportional-hazard models were used to evaluate the association between race/ethnicity and revision risk while adjusting for age, sex, highest educational attainment, annual household income, graft type, and geographic region in which the ACLR was performed.
Of the 27,258 included patients,13,567 (49.8%) were white, 7,713 (28.3%) were Hispanic, 3,725 (13.7%) were Asian, and 2,253 (8.3%) were black. Asian patients (hazard ratio [HR] = 0.72; 95% confidence interval [CI] = 0.57 to 0.90) and Hispanic patients (HR = 0.83; 95% CI = 0.70 to 0.98) had a lower risk of undergoing revision surgery than did white patients. Within the first 3.5 years postoperatively, we did not observe a difference in revision risk when black patients were compared with white patients (HR = 0.86; 95% CI = 0.64 to 1.14); after 3.5 years postoperatively, black patients had a lower risk of undergoing revision (HR = 0.23; 95% CI = 0.08 to 0.63).
In a large, universally insured ACLR cohort with equal access to care, we observed Asian, Hispanic, and black patients to have a similar or lower risk of undergoing elective revision compared with white patients. These findings emphasize the need for additional investigation into barriers to equal access to care. Because of the sensitivity and complexity of race/ethnicity with surgical outcomes, continued assessment into the reasons for the differences observed, as well as any differences in other clinical outcomes, is warranted.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
涉及接受前交叉韧带重建（ACLR）治疗的多族裔患者的大型研究较少，因此，对于种族/民族在 ACLR 后接受翻修手术的风险差异中可能起的作用知之甚少。本研究的目的是评估在普遍参保的 ACLR 患者队列中，种族/民族是否存在接受择期无菌翻修手术的风险差异。
这是一项使用我们综合医疗保健系统的 ACLR 登记处进行的回顾性队列研究，纳入了 2008 年至 2015 年的 ACLR。种族/民族分为以下 4 组：非西班牙裔白人、黑人、西班牙裔和亚裔。多变量 Cox 比例风险模型用于评估种族/民族与翻修风险之间的关联，同时调整年龄、性别、最高教育程度、家庭年收入、移植物类型以及进行 ACLR 的地理位置。
在纳入的 27258 例患者中，13567 例（49.8%）为白人，7713 例（28.3%）为西班牙裔，3725 例（13.7%）为亚裔，2253 例（8.3%）为黑人。与白人患者相比，亚裔患者（风险比[HR] = 0.72；95%置信区间[CI] = 0.57 至 0.90）和西班牙裔患者（HR = 0.83；95% CI = 0.70 至 0.98）接受翻修手术的风险较低。在术后的前 3.5 年内，与白人患者相比，黑人患者的翻修风险没有差异（HR = 0.86；95% CI = 0.64 至 1.14）；术后 3.5 年以上，黑人患者接受翻修的风险较低（HR = 0.23；95% CI = 0.08 至 0.63）。
在一个具有平等获得医疗保健机会的大型、普遍参保的 ACLR 队列中，我们观察到与白人患者相比，亚裔、西班牙裔和黑人患者接受择期翻修的风险相似或更低。这些发现强调了需要进一步调查获得平等医疗保健的障碍。由于种族/民族与手术结果之间的敏感性和复杂性，需要对观察到的差异原因以及其他临床结果差异进行持续评估。
