Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA.
J Shoulder Elbow Surg. 2021 Jul;30(7):1596-1602. doi: 10.1016/j.jse.2020.09.019. Epub 2020 Oct 15.
Patients frequently undergo interventions before shoulder arthroplasty, including injections and arthroscopy. Although the potential impact of injections on postoperative outcomes such as infection has been well studied, it is less clear whether prior arthroscopy has an impact on infection rates after shoulder arthroplasty. The purpose of this study was to determine whether prior ipsilateral shoulder arthroscopy is associated with an increased risk of postoperative infection after shoulder arthroplasty.
Patients who underwent shoulder arthroplasty, including hemiarthroplasty, total shoulder arthroplasty, or reverse shoulder arthroplasty with a minimum of 1-year preoperative database exposure, were queried using Current Procedural Terminology codes from 2 large insurance databases, including both private-payer (Humana, 2008-2017) and Medicare (2006-2014) data. Patients with procedures for infection, fractures, or without laterality data were excluded. Those who underwent ipsilateral shoulder arthroscopy within 2 years before their arthroplasty were identified and compared with controls who did not undergo prior arthroscopy. Each database was analyzed separately. Periprosthetic infection within 1 year after arthroplasty was queried for each group and compared using a logistic regression analysis with control for demographic and comorbidity confounders.
A total of 9362 Medicare patients and 17,716 private-payer patients were included in the study. Of these, 486 (5.2%) Medicare patients and 685 (3.9%) private-payer patients underwent prior arthroscopy. In the Medicare database, prior arthroscopy was also associated with a postarthroplasty infection rate of 3.9% as compared with 1.9% in the control group (odds ratio: 1.96, 95% confidence interval: 1.20-3.22, P = .003). Similarly, in the private insurance cohort, prior shoulder arthroscopy was associated with a postarthroplasty infection rate of 2.9% as compared with 1.4% in the control group (odds ratio: 1.85, 95% confidence interval: 1.13-3.03, P = .005).
Shoulder arthroscopy performed within 2 years before shoulder arthroplasty is associated with a higher infection rate in the first year after shoulder arthroplasty.
患者在肩关节置换术前常接受介入治疗，包括注射和关节镜检查。虽然注射对术后感染等结果的潜在影响已得到充分研究，但关节镜检查是否会影响肩关节置换术后的感染率尚不清楚。本研究旨在确定同侧肩关节镜检查是否与肩关节置换术后感染风险增加有关。
使用 2 个大型保险数据库（包括私人支付者（Humana，2008-2017 年）和 Medicare（2006-2014 年）数据）的当前程序术语代码对至少有 1 年术前数据库暴露的接受肩关节置换术（包括半肩关节置换术、全肩关节置换术或反肩关节置换术）的患者进行查询。排除有感染、骨折或无侧别数据的患者。确定在关节置换前 2 年内接受同侧肩关节镜检查的患者，并与未接受先前关节镜检查的对照组进行比较。对每个数据库分别进行分析。对每组患者术后 1 年内的假体周围感染进行了查询，并使用逻辑回归分析进行了比较，同时控制了人口统计学和合并症混杂因素。
共有 9362 名 Medicare 患者和 17716 名私人支付者患者纳入研究。其中，486 名 Medicare 患者（5.2%）和 685 名私人支付者患者（3.9%）接受了先前的关节镜检查。在 Medicare 数据库中，与对照组（1.9%）相比，先前的关节镜检查也与关节置换后感染率为 3.9%相关（比值比：1.96，95%置信区间：1.20-3.22，P =.003）。同样，在私人保险队列中，与对照组（1.4%）相比，先前的肩关节镜检查与关节置换后感染率为 2.9%相关（比值比：1.85，95%置信区间：1.13-3.03，P =.005）。
在肩关节置换术前 2 年内进行肩关节镜检查与肩关节置换术后 1 年内的感染率较高有关。
