Bryce A Basques1, Elizabeth C Gardner1, Arya G Varthi1, Michael C Fu2, Daniel D Bohl1, Nicholas S Golinvaux1, Jonathan N Grauer3. 1. Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA. 2. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA. 3. Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA jonathan.grauer@yale.edu.
Abstract
BACKGROUND: Recent studies have questioned the efficacy of meniscectomy in older patients with and without evidence of osteoarthritis; however, it continues to be frequently performed. There is limited information about age and other risk factors for adverse events and readmission after the procedure. This knowledge is vital to understand the true risk profile of this common surgery. PURPOSE: To investigate if age and medical comorbidities were risk factors for postoperative adverse events and readmission after meniscectomy. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Patients who underwent arthroscopic meniscectomy between 2005 and 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Age≥65 years and medical comorbidities were evaluated as risk factors for any adverse event (AAE), severe adverse events (SAEs), and readmission after meniscectomy using univariate and multivariate analyses. RESULTS: A total of 17,774 patients who underwent meniscectomy were identified. The mean age was 53.0±13.6 years. A total of 3420 patients (19.2%) were ≥65 years. Overall, 208 patients (1.17%) had AAE, 203 patients (1.14%) had an SAE, and 102 patients were readmitted (0.97%). Multivariate logistic regression analyses demonstrated no significant differences between age groups for the occurrence of AAE, SAEs, and readmission. Patients with American Society of Anesthesiologists classification≥3 had increased odds of AAE (odds ratio [OR], 1.58), SAEs (OR, 1.59), and readmission (OR, 1.99). Patients with diabetes had increased odds of AAE (OR, 1.57) and SAEs (OR, 1.51). Smokers had increased odds of readmission (OR, 1.67). Patients with pulmonary disease had increased odds of AAE (OR, 1.76) and SAEs (OR, 1.70). CONCLUSION: Meniscectomy is a safe procedure in older patients, as age over 65 years did not increase the odds of any of the adverse events studied. However, regardless of age, patients with an increased comorbidity burden and those with a history of smoking are at increased risk of adverse events and/or readmission after the procedure. CLINICAL RELEVANCE: Knowledge of these risk factors for adverse events and readmission provides essential information for patient selection and preoperative counseling.
BACKGROUND: Recent studies have questioned the efficacy of meniscectomy in older patients with and without evidence of osteoarthritis; however, it continues to be frequently performed. There is limited information about age and other risk factors for adverse events and readmission after the procedure. This knowledge is vital to understand the true risk profile of this common surgery. PURPOSE: To investigate if age and medical comorbidities were risk factors for postoperative adverse events and readmission after meniscectomy. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS:Patients who underwent arthroscopic meniscectomy between 2005 and 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Age≥65 years and medical comorbidities were evaluated as risk factors for any adverse event (AAE), severe adverse events (SAEs), and readmission after meniscectomy using univariate and multivariate analyses. RESULTS: A total of 17,774 patients who underwent meniscectomy were identified. The mean age was 53.0±13.6 years. A total of 3420 patients (19.2%) were ≥65 years. Overall, 208 patients (1.17%) had AAE, 203 patients (1.14%) had an SAE, and 102 patients were readmitted (0.97%). Multivariate logistic regression analyses demonstrated no significant differences between age groups for the occurrence of AAE, SAEs, and readmission. Patients with American Society of Anesthesiologists classification≥3 had increased odds of AAE (odds ratio [OR], 1.58), SAEs (OR, 1.59), and readmission (OR, 1.99). Patients with diabetes had increased odds of AAE (OR, 1.57) and SAEs (OR, 1.51). Smokers had increased odds of readmission (OR, 1.67). Patients with pulmonary disease had increased odds of AAE (OR, 1.76) and SAEs (OR, 1.70). CONCLUSION: Meniscectomy is a safe procedure in older patients, as age over 65 years did not increase the odds of any of the adverse events studied. However, regardless of age, patients with an increased comorbidity burden and those with a history of smoking are at increased risk of adverse events and/or readmission after the procedure. CLINICAL RELEVANCE: Knowledge of these risk factors for adverse events and readmission provides essential information for patient selection and preoperative counseling.
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