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前交叉韧带手术后,如果需要进行二次前交叉韧带手术,与再次选择同一位外科医生相关的变量有哪些?

After Anterior Cruciate Ligament Surgery, Variables Associated With Returning to the Same Surgeon If a Subsequent Antrior Cruciate Ligament Surgery Is Needed?

作者信息

Halperin Scott J, Dhodapkar Meera M, McLaughlin William M, Santos Estevao, Medvecky Michael J, Grauer Jonathan N

机构信息

From the Yale Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.

出版信息

J Am Acad Orthop Surg Glob Res Rev. 2024 Dec 31;9(1). doi: 10.5435/JAAOSGlobal-D-24-00349. eCollection 2025 Jan 1.

Abstract

INTRODUCTION

Anterior cruciate ligament reconstructions (ACLrs) unfortunately can require revision ACLr, or contralateral ACLr may be indicated (together subsequent ACLr). This study aimed to examine the rate of and factors associated with returning to the same surgeon.

METHODS

Patients who underwent ACLr and subsequent ACLr within 3 years were abstracted from the PearlDiver database. Patient factors and surgical factors were examined. Factors independently associated with changing the surgeon were examined.

RESULTS

Overall, 63,582 ACLr patients were identified with 2,823 (4.4%) having a subsequent ACLr. These subsequent ACLrs were performed by the same surgeon for 1,329 (47.1%) and by a different surgeon for 1,494 (52.9%). Factors independently associated with changing surgeons were 90-day adverse events after index surgery (odds ratio [OR] 1.95), longer time to second surgery (OR 1.61), and second surgery on the ipsilateral knee (OR 1.28). Notably, sex, comorbidity, depression, psychoses, and insurance plan were not correlated with choosing changing surgeons.

CONCLUSION

Over half of the patients who required a subsequent ACLr changed surgeons. Changing surgeons was associated with adverse events after index surgery, ipsilateral revisions, longer time to surgery, and patient age. However, there should be confidence that the other assessed factors were not associated with the decision to change surgeons.

摘要

引言

不幸的是,前交叉韧带重建术(ACLr)可能需要进行翻修ACLr,或者可能需要进行对侧ACLr(后续一起进行ACLr)。本研究旨在检查回到同一位外科医生处治疗的比率及相关因素。

方法

从PearlDiver数据库中提取在3年内接受ACLr及后续ACLr的患者。检查患者因素和手术因素。研究与更换外科医生独立相关的因素。

结果

总体而言,共识别出63,582例ACLr患者,其中2,823例(4.4%)接受了后续ACLr。这些后续ACLr手术由同一位外科医生进行的有1,329例(47.1%),由不同外科医生进行的有1,494例(52.9%)。与更换外科医生独立相关的因素包括初次手术后90天出现不良事件(比值比[OR]为1.95)、第二次手术时间较长(OR为1.61)以及同侧膝关节进行第二次手术(OR为1.28)。值得注意的是,性别、合并症、抑郁症、精神病和保险计划与选择更换外科医生无关。

结论

超过一半需要进行后续ACLr的患者更换了外科医生。更换外科医生与初次手术后的不良事件、同侧翻修、手术时间较长以及患者年龄有关。然而,应该相信其他评估因素与更换外科医生的决定无关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c10b/11692955/247427e9279b/jagrr-9-e24.00349-g001.jpg

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