Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A.
Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A..
Arthroscopy. 2020 Sep;36(9):2380-2388. doi: 10.1016/j.arthro.2020.05.022. Epub 2020 Jul 9.
To describe the national rates of failed primary rotator cuff repair (RCR) requiring revision repair, using numerous patient characteristics previously defined in orthopaedic literature, including smoking history, diabetes mellitus (DM), hyperlipidemia (HLD), vitamin D deficiency, and osteoporosis to determine which factors independently affect the success of primary RCR.
A combined public and private national insurance database was searched from 2007 to 2016 for all patients who underwent RCR. Current Procedural Terminology codes were used to identify RCRs. Laterality modifiers for the primary surgery were used to identify subsequent revision RCRs. All patients who did not have a linked laterality modifier for the RCR Current Procedural Terminology code were excluded from the study. Basic demographics were recorded. International Classification of Diseases Ninth Revision codes were used to identify patient characteristics including Charlson Comorbidity Index, smoking status, DM, obesity, HLD, vitamin D deficiency, and osteoporosis. Patient age categorized as <60, 60-69, 70-74, or 75+ years old. Dichotomous data were analyzed with χ testing. Multivariable logistic regression was used to characterize independent associations with revision RCR.
Included in the study were 41,467 patients (41,844 shoulders, 52.7% male patients) who underwent primary arthroscopic RCR. Of all arthroscopic RCRs, 3072 patients (3463 shoulders, 53.5% male patients) underwent revision RCR (8.38%). In both primary and revision RCR, patients age 60 to 69 years were most prevalent, accounting for 38.4% and 37.6% of the cohorts, respectively. The average time from primary RCR to revision was 414.9 days (median 214.0 days). Increasing age and male sex (odds ratio [OR] 1.10, P = .019, 95% confidence interval [CI] 1.02-1.19) were significantly predictive of revision RCR. Of the remaining patient characteristics, smoking most strongly predicted revision RCR (OR 1.36, P < .001, CI 1.23-1.49). Obesity (OR 1.32, P < .001, CI 1.21-1.43), hyperlipidemia (OR 1.09, P = .032, CI 1.01-1.18), and vitamin D deficiency (OR 1.18, P < .001, CI 1.08-1.28) also increased risk of revision RCR significantly. DM was found to be protective against revision surgery (OR 0.84, P < .001, CI 0.76-0.92). Overall comorbidity burden as measured by the Charlson Comorbidity Index was not predictive of revision RCR.
Smoking, obesity, vitamin D deficiency, and HLD are shown to be independent risk factors for failure of primary RCR requiring revision RCR. However, despite the suggestions of previous studies, DM, osteoporosis, and overall comorbidity burden did not demonstrate independent associations in this study.
IV, Case Series.
利用先前在骨科文献中定义的大量患者特征，包括吸烟史、糖尿病（DM）、高脂血症（HLD）、维生素 D 缺乏症和骨质疏松症，描述需要修复的初次肩袖修复（RCR）失败的全国发生率，以确定哪些因素独立影响初次 RCR 的成功率。
从 2007 年到 2016 年，在一个公共和私人的全国性保险数据库中搜索所有接受 RCR 的患者。使用当前的程序术语（Current Procedural Terminology，简称 CPT）代码来识别 RCR。初级手术的侧别修饰符用于识别随后的修复 RCR。所有没有 RCR CPT 代码的侧别修饰符的患者均被排除在研究之外。记录基本人口统计学数据。使用国际疾病分类第九版（International Classification of Diseases Ninth Revision，简称 ICD-9）代码来识别患者特征，包括 Charlson 合并症指数、吸烟状况、DM、肥胖症、HLD、维生素 D 缺乏症和骨质疏松症。患者年龄分为<60、60-69、70-74 或 75 岁以上。采用 χ 检验分析二分类数据。采用多变量逻辑回归分析与修复 RCR 相关的独立关联。
研究共纳入 41467 名患者（41844 个肩膀，52.7%为男性患者），接受初次关节镜 RCR。在所有关节镜 RCR 中，有 3072 名患者（3463 个肩膀，53.5%为男性患者）接受了修复 RCR（8.38%）。在初次和修复 RCR 中，年龄在 60 至 69 岁的患者最为常见，分别占队列的 38.4%和 37.6%。初次 RCR 到修复的平均时间为 414.9 天（中位数 214.0 天）。年龄增长和男性（比值比[OR]1.10，P =.019，95%置信区间[CI]1.02-1.19）是修复 RCR 的显著预测因素。在其余的患者特征中，吸烟对修复 RCR 的预测性最强（OR 1.36，P<0.001，CI 1.23-1.49）。肥胖症（OR 1.32，P<0.001，CI 1.21-1.43）、高脂血症（OR 1.09，P=.032，CI 1.01-1.18）和维生素 D 缺乏症（OR 1.18，P<0.001，CI 1.08-1.28）也显著增加了修复 RCR 的风险。DM 被发现对修复手术有保护作用（OR 0.84，P<.001，CI 0.76-0.92）。Charlson 合并症指数所衡量的整体合并症负担与修复 RCR 无关。
吸烟、肥胖症、维生素 D 缺乏症和 HLD 是初次 RCR 修复失败需要修复的独立危险因素。然而，尽管之前的研究有提示，但在本研究中，DM、骨质疏松症和整体合并症负担并没有表现出独立的关联。
IV，病例系列研究。
