RESUMEN
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.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Menisco , Embolia Pulmonar , Tromboembolia Venosa , Humanos , Meniscectomía/efectos adversos , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Artroscopía/efectos adversos , Estudios RetrospectivosRESUMEN
STUDY DESIGN: Case-control study. OBJECTIVES: Evaluate the rate and risk factors for perioperative allogeneic blood transfusion (ABT) in primary idiopathic scoliosis surgery at a single institution. Avoiding perioperative ABT is ideal as transfusions are associated with adverse reactions, increased rates of infection, prolonged hospitalization, additional laboratory testing, and increased cost. Risk factors identified in other studies have differed, and to our knowledge, few studies have identified clinical strategies to predict patients at high risk for ABT. METHODS: We reviewed 402 idiopathic scoliosis patients who underwent primary posterior spinal fusion and instrumentation (PSFI) at a single institution from 2015 to 2017. Medical records and radiographs were reviewed for all patients. Transfused patients were compared to the remaining cohort to find significant differences and identify predictors of higher ABT risk. RESULTS: ABT occurred in 73 patients (18.2%), with the majority of transfusions occurring intraoperatively (41%) or postoperatively on the day of surgery (25%). The seven surgeons involved varied significantly in incidence of ABT (2.4-35.8%, p = 0.002). Patients who had ABT were younger (13.3 vs. 14.1 years, p < 0.01), had lower BMI (48th vs. 61st percentile, p < 0.001), and lower preoperative hemoglobin (13.1 vs. 13.7 g/dL, p < 0.01). Greater preoperative major Cobb angle (69° vs. 61.5°, p < 0.001), number of fusion levels (11.8 vs. 10.3, p < 0.001), and estimated blood loss (770 vs. 448 mL, p < 0.001) also predicted ABT. CONCLUSIONS: ABT was associated with several risk factors, five of which are known preoperatively. Surgeons can use knowledge of these risk factors to assess transfusion risk preoperatively and plan surgery, blood management, and laboratory testing accordingly. The development of best practices for ordering ABT is possible given the variation amongst providers. LEVEL OF EVIDENCE: Level III.