Li Lambert T, Bokshan Steven L, Lemme Nicholas J, Testa Edward J, Owens Brett D, Cruz Aristides I
Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, U.S.A.
Arthrosc Sports Med Rehabil. 2021 Jul 16;3(5):e1279-e1286. doi: 10.1016/j.asmr.2021.05.008. eCollection 2021 Oct.
To determine how patient demographics, socioeconomic status, history of recurrence, and initial point of presentation for health care influenced the decision for surgical treatment following a patellar instability episode.
The New York SPARCS database from 2016 to 2018 was queried for patients aged 21 and younger who were diagnosed with a patellar instability episode. These were linked to later surgeries with Current Procedural Terminology (CPT) codes 27405 (MPFL repair), 27418 (tibial tubercle osteotomy), 27420 (dislocating patella reconstruction), 27422 (Campbell/Roux-Goldthwait procedure), and 27427 (extra-articular knee ligamentous reconstruction). χ-analysis and binary logistic regression were used to assess demographic and injury-specific variables for association with operative management. A generalized linear model was used to estimate charges associated with patellar instability.
There were 2,557 patients with patellar instability, 134 (5.2%) of whom underwent surgery. Patients with recurrent instability had 1.875 times higher odds of undergoing surgery ( = .017). Compared to white patients, black patients had 0.428 times the odds of surgery ( = .004). None of the patients without insurance had surgery. In the cost model, an initial visit to an outpatient office was associated with $1,994 lower charges compared to an emergency department (ED) visit ( < .001). Black patients had $566 more in charges than White patients ( = .009). Compared with nonoperative treatment, surgeries with CPT 27405 added $13,124, CPT 27418 added $10,749, CPT 27422 added $18,981, CPT 27420 added $23,700, and CPT 27427 added $25,032 (all < .001).
Patients with recurrent instability had higher odds of surgery, while Black and uninsured patients had lower odds of surgery. ED visits were associated with significantly higher charges compared to office visits, and Black patients had higher charges than white patients. Minority and uninsured patients may face barriers in access to orthopedic care.
Level III, retrospective cohort study.
确定患者人口统计学特征、社会经济地位、复发史以及首次就医地点如何影响髌骨不稳发作后手术治疗的决策。
查询2016年至2018年纽约州外科和医疗程序统计数据库（SPARCS）中年龄在21岁及以下且被诊断为髌骨不稳发作的患者。这些患者与后来使用当前手术操作术语（CPT）编码27405（内侧髌股韧带修复）、27418（胫骨结节截骨术）、27420（脱位髌骨重建）、27422（坎贝尔/鲁-戈德思韦特手术）和27427（关节外膝关节韧带重建）进行的手术相关联。采用χ分析和二元逻辑回归来评估人口统计学和损伤特异性变量与手术治疗的相关性。使用广义线性模型来估计与髌骨不稳相关的费用。
共有2557例髌骨不稳患者，其中134例（5.2%）接受了手术。复发性不稳患者接受手术的几率高出1.875倍（P = 0.017）。与白人患者相比，黑人患者接受手术的几率为0.428倍（P = 0.004）。没有保险的患者均未接受手术。在费用模型中，与急诊就诊相比，首次门诊就诊的费用低1994美元（P < 0.001）。黑人患者的费用比白人患者多566美元（P = 0.009）。与非手术治疗相比，CPT 27405手术增加13124美元，CPT 27418手术增加10749美元，CPT 27422手术增加18981美元，CPT 27420手术增加23700美元，CPT 27427手术增加25032美元（均P < 0.001）。
复发性不稳患者接受手术的几率更高，而黑人和未参保患者接受手术的几率较低。与门诊就诊相比，急诊就诊的费用显著更高，且黑人患者的费用高于白人患者。少数族裔和未参保患者在获得骨科护理方面可能面临障碍。
III级，回顾性队列研究。
