Columbia University Medical Center, New York, NY, USA.
Columbia University Medical Center, New York, NY, USA.
J Shoulder Elbow Surg. 2020 Dec;29(12):e462-e467. doi: 10.1016/j.jse.2020.05.024. Epub 2020 Jun 12.
The purpose of this study was to evaluate short-term outcomes including medical complications, overnight admission, and 30-day readmission with regard to patient age at the time of shoulder instability surgery.
Patients undergoing surgery for glenohumeral instability were collected from the National Surgical Quality Improvement Program between the years of 2005 and 2016. These patients were separated into cohorts of younger than 25 years, 25-34 years, and older than 34 years. Medical complications, hospital admission, and 30-day readmission were compared using multivariate analysis.
Of the 5449 patients included, there were 2035 (37.0%) patients younger than 25 years, 1815 (33.0%) between 25 and 34 years, and 1649 (30.0%) 35 and older. Overall, 81.7% of patients underwent an arthroscopic Bankart repair, 12.6% of patients underwent an open Bankart repair, and 5.7% of patients underwent a Latarjet-Bristow procedure. The risk of 30-day readmission increased with age, ranging from 0.24% for <25 years old to 0.92% for 35 years and older (P = .040). Operative duration greater than 60 minutes (odds ratio [OR] 1.76; P = .001), duration greater than 90 minutes (OR 3.58; P < .001), and American Society of Anesthesiologists class III and IV (OR 1.80; P = .001) were associated with increased risk of overnight hospital stay. Compared with arthroscopic Bankart repair, the Latarjet-Bristow procedure was associated with increased total complications (OR 3.30; P = .021), overnight hospital stay (OR 4.64; P < .001), and 30-day readmission (OR 3.39; P = .013).
This study demonstrates that even in the relatively young and healthy shoulder instability patient cohort, patients older than 25 years are almost 4 times more likely to experience a complication. Additionally, Latarjet-Bristow procedures are 3-4 times more likely to experience a complication or readmission than other shoulder instability procedures.
本研究旨在评估与肩不稳定手术时患者年龄相关的短期结果，包括医疗并发症、过夜住院和 30 天再入院。
从 2005 年至 2016 年，从国家手术质量改进计划中收集接受盂肱关节不稳定手术的患者。将这些患者分为年龄小于 25 岁、25-34 岁和大于 34 岁的队列。使用多变量分析比较医疗并发症、住院和 30 天再入院。
在 5449 名患者中，有 2035 名（37.0%）患者年龄小于 25 岁，1815 名（33.0%）患者年龄在 25-34 岁之间，1649 名（30.0%）患者年龄在 35 岁及以上。总体而言，81.7%的患者接受了关节镜下 Bankart 修复术，12.6%的患者接受了开放式 Bankart 修复术，5.7%的患者接受了 Latarjet-Bristow 手术。30 天再入院的风险随年龄增加而增加，年龄小于 25 岁的患者为 0.24%，年龄在 35 岁及以上的患者为 0.92%（P =.040）。手术时间超过 60 分钟（比值比 [OR] 1.76；P =.001）、超过 90 分钟（OR 3.58；P <.001）和美国麻醉医师协会 III 级和 IV 级（OR 1.80；P =.001）与过夜住院的风险增加相关。与关节镜下 Bankart 修复术相比，Latarjet-Bristow 手术与总并发症（OR 3.30；P =.021）、过夜住院（OR 4.64；P <.001）和 30 天再入院（OR 3.39；P =.013）的风险增加相关。
本研究表明，即使在相对年轻和健康的肩不稳定患者群体中，25 岁以上的患者发生并发症的可能性也几乎高出 4 倍。此外，与其他肩不稳定手术相比，Latarjet-Bristow 手术发生并发症或再入院的可能性要高出 3-4 倍。
