单纯半月板切除术后1年内关节镜翻修或转换为全膝关节置换术的发生率及危险因素。
Rates and Risk Factors of Revision Arthroscopy or Conversion to Total Knee Arthroplasty Within 1 Year Following Isolated Meniscectomy.
作者信息
Agarwalla Avinesh, Gowd Anirudh K, Liu Joseph N, Amin Nirav H, Werner Brian C
机构信息
Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, New York, U.S.A.
Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, U.S.A.
出版信息
Arthrosc Sports Med Rehabil. 2020 Oct 24;2(5):e443-e449. doi: 10.1016/j.asmr.2020.04.011. eCollection 2020 Oct.
PURPOSE
To identify the rates of and risk factors for revision arthroscopy and conversion to total knee arthroplasty (TKA) within 1 year of isolated meniscectomy.
METHODS
Humana and Medicare national insurance databases were queried for patients who underwent isolated meniscectomy. Patients who underwent revision arthroscopy or TKA within 1 year postoperatively were identified by International Classification of Diseases Procedural Codes, Ninth Revision, and Current Procedural Terminology codes. Multivariate binomial logistic regression analysis was used to identify risk factors, and adjusted odds ratios (ORs) and 95% confidence intervals (Cis) were calculated, with < .05 considered significant.
RESULTS
A total of 13,142 patients and 407,888 patients underwent isolated meniscectomy in the Humana and Medicare databases, respectively. Of the patients, 395 (3.01%) and 3,770 patients (0.92%) underwent revision arthroscopy, and 629 patients (4.79%) and 38,630 patients (9.47%) underwent TKA within 1 year of meniscectomy in the Humana and Medicare databases, respectively. Obesity (Humana: OR = 1.33, = 0.003; Medicare: OR = 1.10, < 0.001) and age < 20 years (Humana: OR = 2.64, = 0.022), 20-29 years (Humana: OR = 3.30, = 0.002), 40-49 years (Humana: OR = 3.80, < 0.001), 50-59 years (Humana: OR = 1.99, = 0.027), and < 64 years (Medicare: OR = 1.74, < 0.001) were risk factors for revision arthroscopy. Obesity (Humana: OR = 1.64, < 0.001; Medicare: OR = 1.37, < 0.001), morbid obesity (Medicare: OR = 1.20, < 0.001), age 70-74 (Medicare: OR = 1.12, < 0.001), 75-79 (Medicare: OR = 1.25, < 0.001), 80-84 (Medicare: OR = 1.20, < 0.001), and concomitant osteoarthritis (Humana: OR = 1.42, < 0.001; Medicare: OR = 1.46, < 0.001) were risk factors for conversion to TKA.
CONCLUSIONS
Medicare and Humana databases showed that 0.92%-3.01% and 4.79%-9.47% of patients undergo revision arthroscopy or conversion to TKA within a year of isolated meniscectomy. Obesity was a risk factor for early revision arthroscopy and conversion to TKA, whereas concomitant osteoarthritis was a risk factor for conversion to TKA.
LEVEL OF EVIDENCE
Level III, retrospective comparative trial
目的
确定单纯半月板切除术后1年内关节镜翻修术和转为全膝关节置换术（TKA）的发生率及危险因素。
方法
查询Humana和医疗保险国家保险数据库中接受单纯半月板切除术的患者。通过国际疾病分类程序编码第九版和当前程序术语编码识别术后1年内接受关节镜翻修术或TKA的患者。采用多变量二项逻辑回归分析确定危险因素，并计算调整后的比值比（OR）和95%置信区间（CI），P<0.05认为具有统计学意义。
结果
Humana和医疗保险数据库中分别有13142例和407888例患者接受了单纯半月板切除术。在这些患者中，Humana数据库中有395例（3.01%）和医疗保险数据库中有3770例（0.92%）接受了关节镜翻修术，Humana数据库中有629例（4.79%）和医疗保险数据库中有38630例（9.47%）在半月板切除术后1年内接受了TKA。肥胖（Humana：OR=1.33，P=0.003；医疗保险：OR=1.10，P<0.001）以及年龄<20岁（Humana：OR=2.64，P=0.022）、20 - 29岁（Humana：OR=3.30，P=0.002）、40 - 49岁（Humana：OR=3.80，P<0.001）、50 - 59岁（Humana：OR=1.99，P=0.027）和<64岁（医疗保险：OR=1.74，P<0.001）是关节镜翻修术的危险因素。肥胖（Humana：OR=1.64，P<0.001；医疗保险：OR=1.37，P<0.001）、病态肥胖（医疗保险：OR=1.20，P<0.001）、年龄70 - 74岁（医疗保险：OR=1.12，P<0.001）、75 - 79岁（医疗保险：OR=1.25，P<0.001）、80 - 84岁（医疗保险：OR=1.20，P<0.001）以及合并骨关节炎（Humana：OR=1.42，P<0.001；医疗保险：OR=1.46，P<0.001）是转为TKA的危险因素。
结论
医疗保险和Humana数据库显示，单纯半月板切除术后1年内，0.92% - 3.01%和4.79% - 9.47%的患者接受了关节镜翻修术或转为TKA。肥胖是早期关节镜翻修术和转为TKA的危险因素，而合并骨关节炎是转为TKA的危险因素。
证据级别
三级，回顾性对比试验
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