From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
J Am Acad Orthop Surg. 2024 Aug 1;32(15):697-704. doi: 10.5435/JAAOS-D-23-00636. Epub 2024 Apr 18.
The risks and benefits of including an arthroscopic subacromial decompression (ASD) during arthroscopic rotator cuff repair (RCR) are uncertain. Some studies suggest no difference in revision surgery rates, whereas others have found higher revision surgery rates associated with concomitant ASD. In this study, we compare mid-term revision surgery rates in patients undergoing arthroscopic RCR with or without concomitant ASD.
A retrospective cohort analysis was conducted using a national all-payer claims database. Current Procedural Terminology and International Classification of Disease , 10th Revision , codes were used to identify patients who underwent primary arthroscopic RCR with or without ASD in the United States. The primary study outcome was revision surgery at 2, 4, and 6 years. Univariate analysis was conducted on demographic variables (age, sex) and comorbidities in the Elixhauser Comorbidity Index using chi-square and Student t -tests. Multivariate analysis was conducted using logistic regression.
A total of 11,188 patients were identified who underwent RCR and met the inclusion criteria. Of those, 8,994 (80%) underwent concomitant ASD. Concomitant ASD was associated with lower odds of all-cause revision surgery to the ipsilateral shoulder at 2 years (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.51 to 0.73), 4 years (OR, 0.60; 95% CI, 0.51 to 0.70), and 6 years (OR, 0.59; 95% CI, 0.51 to 0.69). Concomitant ASD was also associated with lower odds of revision RCR at 2 years (OR, 0.68; 95% CI, 0.53 to 0.86), 4 years (OR, 0.63; 95% CI, 0.50 to 0.78), and 6 years (OR, 0.61; 95% CI, 0.49 to 0.76).
Arthroscopic RCR with concomitant ASD is associated with lower odds of all-cause revision surgery in the ipsilateral shoulder at 2, 4, and 6 years. The lower mid-term revision surgery rates suggest benefits to performing concomitant ASD with primary arthroscopic RCR. Continued research on the mid to long-term benefits of ASD is needed to determine which patient populations benefit most from this procedure.
The data that support the findings of this study are available from the corresponding author upon reasonable request.
在关节镜肩袖修复术（RCR）中进行关节镜下肩峰下减压术（ASD）的风险和益处尚不确定。一些研究表明，翻修手术率没有差异，而另一些研究则发现，同时进行 ASD 会导致更高的翻修手术率。在这项研究中，我们比较了行关节镜 RCR 术患者中是否同时进行 ASD 的中期翻修手术率。
本研究使用全国性的全支付者索赔数据库进行回顾性队列分析。美国使用当前操作术语和国际疾病分类第 10 版编码来确定接受初次关节镜 RCR 术并同时或不伴 ASD 的患者。主要研究结果为术后 2、4 和 6 年的翻修手术。使用卡方检验和学生 t 检验对 Elixhauser 合并症指数中的人口统计学变量（年龄、性别）和合并症进行单变量分析。使用逻辑回归进行多变量分析。
共确定了 11188 例符合纳入标准的行 RCR 术的患者。其中 8994 例（80%）同时进行了 ASD。同时进行 ASD 与同侧肩部的全因翻修手术几率降低相关，在术后 2 年（比值比[OR]，0.61；95%置信区间[CI]，0.51 至 0.73）、4 年（OR，0.60；95%CI，0.51 至 0.70）和 6 年（OR，0.59；95%CI，0.51 至 0.69）。同时进行 ASD 还与同侧肩部的 RCR 翻修手术几率降低相关，在术后 2 年（OR，0.68；95%CI，0.53 至 0.86）、4 年（OR，0.63；95%CI，0.50 至 0.78）和 6 年（OR，0.61；95%CI，0.49 至 0.76）。
在关节镜 RCR 术中同时进行 ASD 与同侧肩部术后 2、4 和 6 年的全因翻修手术几率降低相关。中期翻修手术率较低表明，在初次关节镜 RCR 中同时进行 ASD 具有获益。需要进一步研究 ASD 的中至长期获益，以确定哪些患者群体最受益于该手术。
支持本研究结果的数据可根据合理要求向通讯作者索取。
