关节镜手术与开放性手术治疗化脓性腕关节炎：全国使用趋势及其对住院时间、再次手术、术后再入院和并发症的影响
Arthroscopic Versus Open Treatment of Septic Wrist Arthritis: National Trends in Usage and Impact on Length of Stay, Reoperation, Postoperative Readmissions, and Complications.
作者信息
Moran Thomas E, Wagner Ryan, Bustos Francis P, Lee Glenn E, Forster Grace L, Hakami Lee, DeGeorge Brent R
机构信息
Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA.
Department of Plastic Surgery, University of Virginia, Charlottesville, VA.
出版信息
J Hand Surg Glob Online. 2022 Dec 31;5(2):145-150. doi: 10.1016/j.jhsg.2022.11.010. eCollection 2023 Mar.
PURPOSE
The purpose of this study was to use a national claims database to analyze trends in the usage of arthroscopic versus open irrigation and debridement of septic wrist arthritis and compare complication rates, readmission rates, and reoperation rates between the 2 treatment modalities.
METHODS
The PearlDiver database was used to identify patients in the United States who underwent open or arthroscopic debridement for suspected septic wrist arthritis from 2010 to 2017. Data on patient demographics and comorbidities were obtained. Pearson's chi-square tests were performed to compare the treatment modality to demographic data and the year of diagnosis. Univariate logistic regressions were used to measure differences in 90-day hospital readmission rates, 90-day complication rates, and 1-year reoperation rates.
RESULTS
The database captured 1,145 patients who received treatment for septic arthritis of the wrist during this period. Among these, 212 (18.5%) patients underwent arthroscopic debridement and 933 (81.5%) patients underwent open debridement. Open management was more common in all ages; however, arthroscopic debridement was used more frequently in younger age groups. The proportion of open cases per year seemed to increase over the study period. In limited comparisons, no significant differences were observed in 90-day hospital readmission rates, 90-day complication rates, and 1-year reoperation rates.
CONCLUSIONS
Open irrigation and debridement was the preferred method for treatment of septic wrist arthritis in all age groups and time points in this study. No univariate differences were found between rates of readmission, complications, and reoperations between arthroscopic and open treatment modalities; however, more robust data and analyses are needed to better understand the differences between these approaches, especially across different patient groups.
LEVEL OF EVIDENCE
Prognostic IV.
目的
本研究旨在利用全国索赔数据库分析关节镜下与开放性冲洗清创术治疗化脓性腕关节炎的使用趋势，并比较两种治疗方式的并发症发生率、再入院率和再次手术率。
方法
使用PearlDiver数据库识别2010年至2017年在美国因疑似化脓性腕关节炎接受开放性或关节镜下清创术的患者。获取患者人口统计学和合并症数据。进行Pearson卡方检验以比较治疗方式与人口统计学数据及诊断年份。采用单因素逻辑回归分析来衡量90天医院再入院率、90天并发症发生率和1年再次手术率的差异。
结果
该数据库在此期间记录了1145例接受腕关节化脓性关节炎治疗的患者。其中，212例（18.5%）患者接受了关节镜下清创术，933例（81.5%）患者接受了开放性清创术。开放性治疗在各年龄段更为常见；然而，关节镜下清创术在较年轻年龄组中使用更为频繁。在研究期间，每年开放性病例的比例似乎有所增加。在有限的比较中，90天医院再入院率、90天并发症发生率和1年再次手术率未观察到显著差异。
结论
在本研究中，开放性冲洗清创术是各年龄组和时间点治疗化脓性腕关节炎的首选方法。关节镜下与开放性治疗方式在再入院率、并发症发生率和再次手术率方面未发现单因素差异；然而，需要更有力的数据和分析来更好地理解这些方法之间的差异，尤其是在不同患者群体之间。
证据水平
预后IV级。
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