低手术量和早期职业生涯的外科医生在前交叉韧带重建术后再次手术和出现并发症的风险更高。
Low-Volume and Early-Career Surgeons Have Higher Risk for Reoperation and Complications Following Anterior Cruciate Ligament Reconstruction.
作者信息
Foley Aidan J, Halvorson Ryan T, Nosrat Cameron, Ho Brandon R, Nawari Ashraf N, Terada-Herzer Kirk, Feeley Brian T, Lansdown Drew A, Ma C Benjamin, Zhang Alan L
机构信息
University of California, San Francisco, School of Medicine, San Francisco, California, U.S.A.
Department of Orthopaedic Surgery, University of California, San Francisco, California, U.S.A.
出版信息
Arthroscopy. 2025 Jul;41(7):2433-2439.e1. doi: 10.1016/j.arthro.2024.10.017. Epub 2024 Oct 28.
PURPOSE
To characterize the population of surgeons performing anterior cruciate ligament reconstructions (ACLRs) in the United States and investigate the relationships between surgeon volume, career duration, and practice setting on surgical outcomes.
METHODS
A large nationwide insurance database was queried for patients undergoing primary ACLR. Provider gender, degree type (allopathic vs osteopathic), practice setting (academic vs private as defined by ACGME affiliation), surgeon volume per year, and career duration were obtained. Reoperations, hospitalizations, and emergency department visits were recorded. The relationships between surgeon-specific factors and postoperative outcomes were investigated through univariable and multivariable analyses controlling for patient factors such as age, gender, and comorbidities.
RESULTS
54,498 patients underwent ACLR by 3,782 surgeons between 2015 and 2019 with a minimum 2-year follow-up. 97.2% of the surgeons were male, and 90.9% had an allopathic degree. Multivariate analysis controlling for patient variables, including age, gender, and comorbidities revealed surgeons with low yearly ACLR case volume demonstrated higher risk for revision ACLR, while surgeons with high yearly case volume had lower revision ACLR rates (P = .02, P =.003). Additionally, low-case volume per year had higher rates of emergency department visits (P = .01). Early career surgeons had higher rates of both ACLR and non-ACLR arthroscopic reoperations (P < .001, P = .006), as well as increased emergency department visits (P < .001). Academic affiliation was independently associated with greater non-ACLR reoperations (P < .001), emergency department visits (P = .007), and hospital readmissions (.006).
CONCLUSIONS
Patients undergoing ACLR by early career surgeons and surgeons with low yearly ACLR case volume were at increased risk for revision ACLR and postoperative ED visits.
LEVEL OF EVIDENCE
Level III, Retrospective cohort study.
目的
描述在美国进行前交叉韧带重建术（ACLR）的外科医生群体，并研究外科医生的手术量、职业生涯时长和执业环境与手术结果之间的关系。
方法
查询一个大型全国性保险数据库，以获取接受初次ACLR的患者信息。获取医疗服务提供者的性别、学位类型（西医 vs 正骨疗法）、执业环境（根据美国毕业后医学教育认证委员会（ACGME）的附属关系定义为学术型 vs 私立型）、每年的外科医生手术量以及职业生涯时长。记录再次手术、住院和急诊就诊情况。通过单变量和多变量分析，在控制患者因素（如年龄、性别和合并症）的情况下，研究外科医生特定因素与术后结果之间的关系。
结果
2015年至2019年期间，3782名外科医生为54498例患者进行了ACLR，且至少随访2年。97.2%的外科医生为男性，90.9%拥有西医学位。在控制包括年龄、性别和合并症等患者变量的多变量分析中，显示每年ACLR病例量低的外科医生进行ACLR翻修手术的风险更高，而每年病例量高的外科医生ACLR翻修率较低（P = 0.02，P = 0.003）。此外，每年病例量低的医生急诊就诊率更高（P = 0.01）。早期职业生涯的外科医生ACLR和非ACLR关节镜再次手术率均较高（P < 0.001，P = 0.006），急诊就诊次数也增加（P < 0.001）。学术附属关系与更多的非ACLR再次手术（P < 0.00
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