Glasgow Royal Infirmary, Glasgow, UK.
Royal Infirmary of Edinburgh, Edinburgh, UK.
Bone Joint J. 2020 Mar;102-B(3):360-364. doi: 10.1302/0301-620X.102B3.BJJ-2019-0752.R2.
The aim of this study was to examine the recent trend in delivery of arthroscopic subacromial decompression (ASD) in Scotland and to determine if this varies by geographical location.
Scottish Morbidity Records were reviewed retrospectively between March 2014 and April 2018 to identify records for every admission to each NHS hospital. The Office of Population Censuses and Surveys (OPCS-4) surgical codes were used to identify patients undergoing primary ASD. Patients who underwent acromioclavicular joint excision (ACJE) and rotator cuff repair (RCR) were identified and grouped separately. Procedure rates were age and sex standardized against the European standard population.
During the study period the number of ASDs fell by 649 cases (29%) from 2,217 in the first year to 1,568 in the final year. The standardized annual procedure rate fell from 41.6 (95% confidence interval (CI) 39.9 to 43.4) to 28.9 (95% CI 27.4 to 30.3) per 100,000. The greatest reduction occurred between 2017 and 2018. The number of ACJEs rose from 41 to 188 (a 3.59-fold increase). The number of RCRs fell from 655 to 560 (-15%). In the year 2017 to 2018 there were four (28.6%) Scottish NHS board areas where the ASD rate was greater than 3 standard deviations (SDs) from the national average, and two (14.3%) NHS boards where the rate was less than 3 SDs from the national average.
There has been a clear decline in the rate of ASD in Scotland since 2014. Over the same period there has been an increase in the rate of ACJE. The greatest decline occurred between 2017 and 2018, corresponding to the publication of epidemiological studies demonstrating a rise in ASD, and awareness of studies which questioned the benefit of ASD. This paper demonstrates the potential impact of information from epidemiological studies, referral guidelines, and well-designed large multicentre randomized controlled trials on clinical practice. Cite this article: 2020;102-B(3):360-364.
本研究旨在探讨苏格兰关节镜下肩峰下减压术（ASD）的近期趋势，并确定其是否因地理位置而异。
回顾性分析 2014 年 3 月至 2018 年 4 月期间苏格兰每例 NHS 医院每位患者的住院记录。采用英国国家医疗服务体系（NHS）的手术编码（OPCS-4）识别行初次 ASD 的患者。单独识别并分组行肩锁关节切除术（ACJE）和肩袖修复术（RCR）的患者。根据欧洲标准人口对手术率进行年龄和性别标准化。
研究期间，ASD 手术数量从第一年的 2217 例减少了 649 例（29%），最后一年为 1568 例。标准化年度手术率从 41.6（95%置信区间（CI）39.9 至 43.4）降至 28.9（95%CI 27.4 至 30.3）/100000。最大降幅发生在 2017 年至 2018 年之间。ACJE 的数量从 41 例增加到 188 例（增加 3.59 倍）。RCR 的数量从 655 例减少到 560 例（减少 15%）。在 2017 年至 2018 年期间，有四个（28.6%）苏格兰 NHS 董事会地区的 ASD 率比全国平均水平高出 3 个标准差（SD），有两个（14.3%）董事会地区的 ASD 率比全国平均水平低 3 个 SD。
自 2014 年以来，苏格兰 ASD 的发病率明显下降。同期，ACJE 的发病率有所上升。最大降幅发生在 2017 年至 2018 年之间，这与发表的流行病学研究表明 ASD 发病率上升以及对 ASD 益处的质疑性研究相一致。本文证明了流行病学研究、转诊指南和设计良好的大型多中心随机对照试验的信息对临床实践的潜在影响。
2020;102-B（3）：360-364.
