Bi Andrew S, Li Zachary I, Triana Jairo, Fisher Nina D, Morgan Allison M, Garra Sharif, Gonzalez-Lomas Guillem, Campbell Kirk A, Jazrawi Laith M
Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A.
Arthrosc Sports Med Rehabil. 2023 Jul 1;5(4):100748. doi: 10.1016/j.asmr.2023.05.005. eCollection 2023 Aug.
To determine the effect of perioperative angiotensin II receptor blocker (ARB) or angiotensin-converting enzyme inhibitors (ACEi) on postoperative arthrofibrosis, as defined by requiring manipulation under anesthesia (MUA) or new diagnosis of adhesive capsulitis (AC) following arthroscopic shoulder procedures.
Patients were retrospectively identified using Current Procedural Terminology surgical billing codes to identify patients who underwent any shoulder arthroscopic procedure at a single urban academic institution from 2012 to 2020 with a minimum 2-year follow-up. Patients were excluded if <30 years old at time of surgery, as these patients rarely use ARB and ACEi medications, or if they had pre-existing AC. Demographics, active medication prescriptions at the time of surgery, and medical comorbidities were recorded. Multivariable logistic regression was performed to determine the effect of ARB/ACEi on subsequent MUA or AC by 90 days, 1 year, and 2 years.
In total, 5,559 patients were included in the final analysis. A majority of the cohort (53.4%) underwent arthroscopic surgery between the ages of 50 to 69 years. Most patients were male (61.8%) and without obesity (67.3%). In total, 18.9% and 15.0% were taking an ARB or ACEi medication perioperatively, respectively. Within 2 years' postoperatively, 51 patients (0.9%) underwent subsequent ipsilateral MUA, and 174 patients (3.1%) developed AC. Patients taking ARBs had a 17.5% rate of postoperative arthrofibrosis within 2-years compared with 19.1% in those not on ARBs, although this difference was not significant ( = .58). Likewise, no significant difference was found between those taking ACEi versus not (15.0% vs 15.0%, = .99). Individual generic ARB/ACEi subgroup analysis did not demonstrate any significant associations with rate of postoperative arthrofibrosis ( > .05).
ARBs or ACEi did not significantly affect the rate of postoperative arthrofibrosis following shoulder arthroscopy, however female sex, diabetes mellitus, and Black/African American race were associated with an increased rate of necessitating MUA or developing AC within 2 years postoperatively.
Level III, retrospective cohort study.
确定围手术期使用血管紧张素II受体阻滞剂（ARB）或血管紧张素转换酶抑制剂（ACEi）对术后关节纤维化的影响，术后关节纤维化定义为关节镜下肩部手术后需要在麻醉下进行手法操作（MUA）或新诊断为粘连性关节囊炎（AC）。
使用当前程序术语手术计费代码对患者进行回顾性识别，以确定2012年至2020年在一家城市学术机构接受任何肩部关节镜手术且至少随访2年的患者。如果患者手术时年龄小于30岁（因为这些患者很少使用ARB和ACEi药物）或已有AC，则将其排除。记录患者的人口统计学资料、手术时的现行药物处方和合并症。进行多变量逻辑回归分析，以确定ARB/ACEi在90天、1年和2年时对随后发生MUA或AC的影响。
最终分析共纳入5559例患者。大多数队列患者（53.4%）在50至69岁之间接受关节镜手术。大多数患者为男性（61.8%）且无肥胖（67.3%）。总共18.9%和15.0%的患者在围手术期分别服用ARB或ACEi药物。术后2年内，51例患者（0.9%）随后接受了同侧MUA，174例患者（3.1%）发生了AC。服用ARB的患者在2年内术后关节纤维化发生率为17.5%，未服用ARB的患者为19.1%，尽管差异无统计学意义（P = 0.58）。同样，服用ACEi与未服用ACEi的患者之间也未发现显著差异（15.0%对15.0%，P = 0.99）。对个别通用ARB/ACEi亚组分析未显示与术后关节纤维化发生率有任何显著关联（P>0.05）。
ARB或ACEi对肩部关节镜检查术后关节纤维化发生率无显著影响，然而女性、糖尿病以及黑人/非裔美国人种族与术后2年内需要进行MUA或发生AC的发生率增加有关。
III级，回顾性队列研究。
