关节镜半月板修复和切除术的早期低并发症发生率。
Low early complication rates after arthroscopic meniscus repair and meniscectomy.
机构信息
Department of Orthopaedic Surgery, UCI Health, 101 The City Drive S. Pavilion III, 2nd Floor, Orange, CA, 92868, USA.
Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2023 Oct;31(10):4117-4123. doi: 10.1007/s00167-023-07507-8. Epub 2023 Jul 14.
PURPOSE
To evaluate the 30-day complication rates after arthroscopic meniscus repair and meniscectomy using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, with subgroup analysis of patients aged > 40 years.
METHODS
NSQIP registries between 2006 and 2019 were queried using Current Procedural Terminology codes to identify patients undergoing arthroscopic meniscus repair (CPT 29882, 29883) and meniscectomy (29880, 29881). The following 30-day complications were assessed: pulmonary embolism (PE), venous thromboembolism (VTE), surgical site infection (SSI), reoperation, and readmission. Complications rates between treatment groups were compared using multivariate logistic regression analyses adjusted for sex, age, steroid use, and smoking/dyspnoea/COPD. A subgroup analysis was performed for patients aged > 40 years.
RESULTS
A total 6354 meniscus repairs and 99,372 meniscectomies were identified. Complication rates were < 1% for both meniscus repair and meniscectomy. Meniscus repair was associated with significantly higher rates of PE, VTE, and readmission compared to meniscectomy: PE (0.2% vs 0.1%, p < 0.001), VTE (0.8% vs 0.4%, p < 0.001), superficial SSI (0.1% vs 0.2%, n.s), deep SSI (0.07% vs 0.1%, n.s), reoperation (0.5% vs 0.4%, n.s), and readmission (0.9% vs 0.8%, p = 0.003). Among patients aged > 40 years, complication rates were < 1.3% for both meniscus repair and meniscectomy. Similar trends and rates were found in patients aged > 40 years undergoing meniscus repair versus meniscectomy: PE (0.38% vs 0.12%, p < 0.001), VTE (1.07% vs 0.46%, p < 0.001), superficial SSI (0.03% vs 0.19%, n.s), deep SSI (0.1% vs 0.06%, n.s), reoperation (0.48% vs 0.43%, n.s), and readmission (1.2% vs 0.85%, p = 0.01).
CONCLUSION
Arthroscopic meniscus repair and meniscectomy are both low-risk procedures with 30-day complication rates < 1% overall and < 1.3% among patients aged > 40 years. These findings support meniscus repair whenever feasible in the setting of preserved articular cartilage. Understanding of the short-term complication rates after arthroscopic meniscus repair and meniscectomy can aid surgeons in providing comprehensive preoperative counselling to patients considering such treatments, specifically when discussing the risks and benefits of meniscus repair.
LEVEL OF EVIDENCE
III.
目的
利用美国外科医师学院国家手术质量改进计划（ACS-NSQIP）数据库评估关节镜半月板修复和半月板切除术术后 30 天的并发症发生率，并对年龄大于 40 岁的患者进行亚组分析。
方法
使用当前手术程序代码（CPT 29882、29883）和半月板切除术（29880、29881）在 2006 年至 2019 年期间的 NSQIP 登记处查询 ACS-NSQIP 数据库，以确定接受关节镜半月板修复和半月板切除术的患者。评估以下 30 天的并发症：肺栓塞（PE）、静脉血栓栓塞症（VTE）、手术部位感染（SSI）、再次手术和再入院。使用多元逻辑回归分析比较治疗组之间的并发症发生率，并对性别、年龄、类固醇使用和吸烟/呼吸困难/COPD 进行调整。对年龄大于 40 岁的患者进行了亚组分析。
结果
共确定了 6354 例半月板修复术和 99372 例半月板切除术。半月板修复术和半月板切除术的并发症发生率均低于 1%。与半月板切除术相比，半月板修复术与更高的 PE、VTE 和再入院率相关：PE（0.2%比 0.1%，p<0.001）、VTE（0.8%比 0.4%，p<0.001）、浅表 SSI（0.1%比 0.2%，无统计学意义）、深部 SSI（0.07%比 0.1%，无统计学意义）、再次手术（0.5%比 0.4%，无统计学意义）和再入院（0.9%比 0.8%，p=0.003）。在年龄大于 40 岁的患者中，半月板修复术和半月板切除术的并发症发生率均低于 1.3%。在年龄大于 40 岁的患者中，行半月板修复术与半月板切除术的并发症发生率和趋势相似：PE（0.38%比 0.12%，p<0.001）、VTE（1.07%比 0.46%，p<0.001）、浅表 SSI（0.03%比 0.19%，无统计学意义）、深部 SSI（0.1%比 0.06%，无统计学意义）、再次手术（0.48%比 0.43%，无统计学意义）和再入院（1.2%比 0.85%，p=0.01）。
结论
关节镜半月板修复术和半月板切除术都是低风险手术，总体 30 天并发症发生率低于 1%，年龄大于 40 岁的患者并发症发生率低于 1.3%。这些发现支持在关节软骨保持完好的情况下尽可能进行半月板修复。了解关节镜半月板修复和半月板切除术后的短期并发症发生率，可以帮助外科医生为考虑此类治疗的患者提供全面的术前咨询，特别是在讨论半月板修复的风险和益处时。
证据水平
III。
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