半月板桶柄样撕裂行半月板切除术与修复术的疗效与患者、社会经济学和医院因素相关。
Bucket-Handle Meniscus Tear Management With Meniscectomy Versus Repair Correlates With Patient, Socioeconomic, and Hospital Factors.
机构信息
From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT (Mercier, Galivanche, Efthymiou, Wilhelm, Grauer, and Gardner), the Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada (Mercier), and the Department of Orthopaedic Surgery, San Francisco School of Medicine, University of California, San Francisco, CA (Galivanche).
出版信息
J Am Acad Orthop Surg. 2023 Jun 1;31(11):565-573. doi: 10.5435/JAAOS-D-21-01052. Epub 2022 Nov 9.
INTRODUCTION
Bucket-handle meniscus tears are common knee injuries that are often treated surgically with meniscectomy or meniscal repair. Although clinical factors may influence the choice of one treatment approach over the other, the influence of patient, socioeconomic, and hospital factors remains poorly characterized. This study aimed to estimate the relative nationwide utilization of these two procedures and delineate a variety of factors that are associated with the selection of one treatment approach over the other.
METHODS
Meniscal repair and meniscectomy procedures conducted for isolated bucket-handle meniscus tears in 2016 and 2017 were identified in the Nationwide Ambulatory Surgery Sample database. Cases were weighted using nationally representative discharge weights. Univariate analyses and a multivariable logistic regression model were used to compare patient, socioeconomic, and hospital factors associated with meniscal repair versus meniscectomy.
RESULTS
In total, 12,239 cases were identified, which represented 17,236 cases after weighting. Of these, meniscal repair was conducted for 4,138 (24.0%). Based on the logistic regression model, meniscal repair was less likely for older and sicker patients. By contrast, several factors were associated with markedly higher odds of undergoing meniscal repair compared with meniscectomy. These included urban teaching hospitals; geographic location in the midwest, south, and west; and higher median household income.
DISCUSSION
Using a large nationally representative cohort, the current data revealed that only 24.0% of surgically treated bucket-handle meniscus tears were treated using repair. Identification of patient, socioeconomic, and hospital factors differentially associated with meniscal repair suggest that other factors may systematically influence surgical decision-making for this patient population. Surgeons should be conscious of these potential healthcare disparities when determining the optimal treatment for their patients.
LEVEL OF EVIDENCE
Level III.
简介
桶柄状半月板撕裂是常见的膝关节损伤，通常采用半月板切除术或半月板修复术进行治疗。尽管临床因素可能会影响治疗方法的选择，但患者、社会经济和医院因素的影响仍未得到充分描述。本研究旨在评估这两种手术方法的全国相对利用率，并确定与选择一种治疗方法而不是另一种方法相关的各种因素。
方法
在全国门诊手术样本数据库中，确定了 2016 年和 2017 年对孤立性桶柄状半月板撕裂进行的半月板修复和半月板切除术手术。使用全国代表性的出院权重对病例进行加权。使用单变量分析和多变量逻辑回归模型比较与半月板修复与半月板切除术相关的患者、社会经济和医院因素。
结果
共确定了 12239 例病例，加权后代表 17236 例。其中，4138 例（24.0%）进行了半月板修复。根据逻辑回归模型，半月板修复更不可能用于年龄较大和病情较重的患者。相比之下，一些因素与半月板修复的可能性显著增加有关，而不是半月板切除术。这些因素包括城市教学医院；位于中西部、南部和西部的地理位置；以及较高的家庭中位数收入。
讨论
使用大型全国代表性队列，本研究数据显示，仅 24.0%的手术治疗桶柄状半月板撕裂采用修复方法。确定与半月板修复相关的患者、社会经济和医院因素差异表明，其他因素可能会系统地影响该患者群体的手术决策。外科医生在为患者确定最佳治疗方案时应注意这些潜在的医疗保健差异。
证据水平
III 级。
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