肩袖撕裂伴或不伴既往肩袖修复失败的反肩关节置换术：一项大规模对比分析。
Reverse shoulder arthroplasty for rotator cuff tears with and without prior failed rotator cuff repair: A large-scale comparative analysis.
作者信息
Vervaecke Alexander J, Carbone Andrew D, Zubizarreta Nicole, Poeran Jashvant, Parsons Bradford O, Verborgt Olivier, Galatz Leesa M, Cagle Paul J
机构信息
The Mount Sinai Hospital, Department of Orthopaedics, NYC, USA.
Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
出版信息
J Orthop. 2022 Mar 8;31:1-5. doi: 10.1016/j.jor.2022.03.002. eCollection 2022 May-Jun.
BACKGROUND
Large-scale data assessing the effect of a prior failed rotator cuff repair (RCR) on the outcome of reverse shoulder arthroplasty (RSA) is currently lacking. Therefore, this study aimed (1) to assess the course of patients undergoing RCR, specifically focusing on the need for conversion to RSA within two years, and (2) to compare outcomes following RSA performed for rotator cuff tears (RCTs) with and without prior RCR.
METHODS
This retrospective cohort study included data from the CMS Data Set (2016-2018). For the first study objective, we included patients undergoing an RCR; these were followed for 24 months to identify a conversion to RSA. For the second study objective, we included RSAs for RCTs, stratified by those with and without a prior RCR (preceding 24 months). Outcomes (hospitalization cost, institutional post-acute care discharge, 90-day readmission and health resource utilization up to 6 months post-RSA) were compared between propensity score-matched groups.
RESULTS
Out of 33,244 RCRs, 433 (1.3%) patients underwent RSA conversion within two years. Among 7534 RSA cases for RCTs, 245 (3.3%) had an RCR in the preceding two years. In the propensity score analysis, except for a minimal increase in the number of physical rehabilitation visits (RR 1.10; p = 0.0009), no differences were observed between those with and without prior RCR in terms of other RSA outcomes. These included hospitalization cost, discharge to institutional post-acute care facility, 90-day readmission and 6-month post-op cost.
CONCLUSION
Rotator cuff repair in elderly patients, when utilizing currently employed indication criteria, results in low conversion rates to RSA within 2 years postoperatively. Furthermore, large dataset outcomes after RSA for RCT such as cost, post-acute care discharge, physical rehabilitation, and readmission rates appear not to be negatively affected by the presence of a prior RCR.
LEVEL OF EVIDENCE
Level 3 evidence; Retrospective cohort study.
背景
目前缺乏大规模数据来评估既往肩袖修复术（RCR）失败对反肩关节置换术（RSA）疗效的影响。因此，本研究旨在：（1）评估接受RCR治疗的患者病程，特别关注两年内转为RSA的必要性；（2）比较因肩袖撕裂（RCT）行RSA手术且有或无既往RCR患者的疗效。
方法
这项回顾性队列研究纳入了医疗保险和医疗补助服务中心数据集（2016 - 2018年）的数据。对于第一个研究目标，我们纳入了接受RCR治疗的患者；对这些患者随访24个月，以确定是否转为RSA。对于第二个研究目标，我们纳入了因RCT行RSA手术的患者，并根据是否有既往RCR（前24个月内）进行分层。在倾向得分匹配组之间比较了疗效（住院费用、机构急性后期护理出院情况、90天再入院率以及RSA术后6个月内的卫生资源利用情况）。
结果
在33244例RCR手术中，433例（1.3%）患者在两年内接受了RSA转换手术。在7534例因RCT行RSA手术的病例中，245例（3.3%）在之前两年内接受过RCR。在倾向得分分析中，除了物理康复就诊次数略有增加（相对危险度1.10；p = 0.0009）外，有或无既往RCR的患者在其他RSA疗效方面未观察到差异。这些疗效包括住院费用、出院至机构急性后期护理设施、90天再入院率和术后6个月费用。
结论
老年患者采用目前使用的确切标准进行肩袖修复术，术后2年内转为RSA的转化率较低。此外，因RCT行RSA术后的大型数据集疗效，如费用、急性后期护理出院情况、物理康复和再入院率，似乎不受既往RCR的负面影响。
证据水平
3级证据；回顾性队列研究。
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