Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.
University of Virginia, School of Medicine, Charlottesville, Virginia, U.S.A.
Arthroscopy. 2023 Jun;39(6):1386-1393.e4. doi: 10.1016/j.arthro.2022.12.026. Epub 2022 Dec 29.
The purpose of the current study was to use a nationwide administrative-claims database to characterize the substance use disorder trends of patients undergoing arthroscopic rotator cuff repair (RCR). Additionally, we sought to evaluate the influence of preoperative substance use disorder on postoperative outcomes following arthroscopic RCR.
The Mariner database was used to identify patients undergoing RCR using CPT codes, ages 18-84 years old, from 2010 to 2019. Patients were stratified by substance use, including cannabis, cocaine, nicotine, alcohol, opioids, stimulants, or sedative, as defined by International Classification of Diseases (ICD) codes. Substance use disorders trends were reported. Postoperative outcomes assessed consisted of major complications, minor complications, infections, readmissions, and Emergency Department visits within 90 days of surgery. Additionally, postoperative stiffness, revision surgery, and conversion to arthroplasty within 1 year were evaluated. Multivariate logistic regressions were used to control for demographic and comorbid factors.
Substance use trends from 2010 to 2019 show an increase in documentation of substance use in patients undergoing RCR. Individuals with a history of substance use disorder had an increased risk of adverse outcomes, most notably major medical complications (odds ratio [OR]: 1.63; 95% confidence interval [CI]: 1.44-1.86; P < .001), revision surgery (OR: 1.43; 95% CI: 1.30-1.56; P < .001), and conversion to arthroplasty (OR: 1.40; 95% CI: 1.08-1.80; P = .009). Subgroup analysis demonstrated that cannabis users were at higher risk for major medical complications (OR: 1.75; 95% CI: 1.15-2.56; P < .001), conversion to arthroplasty (OR: 3.54; 95% CI: 1.77-6.4; P < .001), and revision (OR: 1.53; 95% CI: 1.12-2.04; P < .05) compared to controls. Additionally, substance use was associated with higher medical costs in terms of procedural cost (β; $3634: $3,490-3,777) and 90-day postoperative costs (β: $436; $375-$498).
Documentation of substance use disorder is increasing in individuals undergoing arthroscopic rotator cuff repair. Substance use is associated with higher rates of postoperative complications, overall costs, and revision surgery following arthroscopic RCR. Nicotine and cannabis use were most commonly associated with increased rates of postoperative complications and treatment failure.
IV, retrospective therapeutic case series.
本研究旨在利用全国性的行政索赔数据库，描述接受关节镜肩袖修复术（RCR）患者的物质使用障碍趋势。此外，我们还评估了术前物质使用障碍对关节镜 RCR 术后结局的影响。
使用 Mariner 数据库，根据 CPT 代码，确定 2010 年至 2019 年期间接受 RCR 的患者，年龄 18-84 岁。根据国际疾病分类（ICD）代码，将患者分为物质使用组，包括大麻、可卡因、尼古丁、酒精、阿片类药物、兴奋剂或镇静剂。报告了物质使用障碍的趋势。评估的术后结局包括 90 天内的主要并发症、小并发症、感染、再入院和急诊就诊。此外，还评估了术后僵硬、翻修手术和 1 年内转为关节置换术的情况。多变量逻辑回归用于控制人口统计学和合并症因素。
2010 年至 2019 年的物质使用趋势显示，接受 RCR 的患者中物质使用记录有所增加。有物质使用障碍史的患者发生不良结局的风险增加，尤其是主要医疗并发症（比值比 [OR]：1.63；95%置信区间 [CI]：1.44-1.86；P <.001）、翻修手术（OR：1.43；95% CI：1.30-1.56；P <.001）和转为关节置换术（OR：1.40；95% CI：1.08-1.80；P = 0.009）。亚组分析表明，与对照组相比，大麻使用者发生主要医疗并发症（OR：1.75；95% CI：1.15-2.56；P <.001）、转为关节置换术（OR：3.54；95% CI：1.77-6.4；P <.001）和翻修手术（OR：1.53；95% CI：1.12-2.04；P <.05）的风险更高。此外，与对照组相比，物质使用与程序成本（β；$3634：$3490-3777）和 90 天术后成本（β：$436；$375-498）的增加有关。
接受关节镜肩袖修复术的患者中，物质使用障碍的记录正在增加。物质使用与关节镜 RCR 术后更高的并发症发生率、总体成本和翻修手术相关。尼古丁和大麻的使用与更高的术后并发症和治疗失败发生率最相关。
IV，回顾性治疗病例系列。
