Ryan M Degen1, Yekaterina Lebedeva2, Trevor B Birmingham2,3, Jacquelyn D Marsh2, Alan M J Getgood4, J Robert Giffin4, Kevin Willits4, Robert B Litchfield4, Dianne Bryant2. 1. Fowler Kennedy Sport Medicine Clinic, Western University, 3M Centre, 1151 Richmond Street, London, ON, N6A 3K7, Canada. Ryan.degen@lhsc.on.ca. 2. Faculty of Health Sciences, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada. 3. Wolf Orthopedics Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, Western University, 3M Centre, 1151 Richmond Street, London, ON, N6A 3K7, Canada. 4. Fowler Kennedy Sport Medicine Clinic, Western University, 3M Centre, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
Abstract
PURPOSE: To evaluate the longitudinal trends in knee arthroscopy utilization in relation to published negative randomized controlled trials, focusing on annual rates, patient demographics and associated 30-day post-operative complications. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology billing codes to identify arthroscopy cases between 2006 and 2016. 30-day post-operative complications were identified, and potential risk factors analysed using univariate and multivariate analyses. RESULTS: 68,346 patients underwent knee arthroscopy, of which 47,446 (69.5%) represented partial meniscectomies. The annual procedural rate, as a proportion of all reported cases, increased significantly from 2006 (0.3%) to 2016 (1.6%; p < 0.001), along with a significant increase in average patient age (44.3 ± 15.5 to 48.4 ± 14.5; p < 0.001). Specifically focusing on the meniscectomy cohort, average patient age significantly increased from 47.9 ± 15.1 to 50.7 ± 13.5 (p = 0.001). The overall incidence of complications was 2.0% (n = 1333), with major complications in 0.9% (n = 639) and minor complications in 1.0% (n = 701). Common complications included a return to the operating room (0.5%), deep vein thrombosis/thrombophlebitis (0.4%), and superficial infection (0.2%). Operating time > 90 min, diabetes, steroid use, ASA class 2+, and dialysis-dependency were the predictors of overall complication rates. CONCLUSION: Despite the publication of negative trials and new clinical practice guidelines, knee arthroscopy utilization and average patient age continue to increase. Given the high utilization, even low adverse event rates equate to substantial numbers of patients with minor and major complications. The NSQIP data show a gap in knowledge translation to clinical practice and highlight the need for improved clinical guidelines. LEVEL OF EVIDENCE: Cohort study; Level III.
PURPOSE: To evaluate the longitudinal trends in knee arthroscopy utilization in relation to published negative randomized controlled trials, focusing on annual rates, patient demographics and associated 30-day post-operative complications. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology billing codes to identify arthroscopy cases between 2006 and 2016. 30-day post-operative complications were identified, and potential risk factors analysed using univariate and multivariate analyses. RESULTS: 68,346 patients underwent knee arthroscopy, of which 47,446 (69.5%) represented partial meniscectomies. The annual procedural rate, as a proportion of all reported cases, increased significantly from 2006 (0.3%) to 2016 (1.6%; p < 0.001), along with a significant increase in average patient age (44.3 ± 15.5 to 48.4 ± 14.5; p < 0.001). Specifically focusing on the meniscectomy cohort, average patient age significantly increased from 47.9 ± 15.1 to 50.7 ± 13.5 (p = 0.001). The overall incidence of complications was 2.0% (n = 1333), with major complications in 0.9% (n = 639) and minor complications in 1.0% (n = 701). Common complications included a return to the operating room (0.5%), deep vein thrombosis/thrombophlebitis (0.4%), and superficial infection (0.2%). Operating time > 90 min, diabetes, steroid use, ASA class 2+, and dialysis-dependency were the predictors of overall complication rates. CONCLUSION: Despite the publication of negative trials and new clinical practice guidelines, knee arthroscopy utilization and average patient age continue to increase. Given the high utilization, even low adverse event rates equate to substantial numbers of patients with minor and major complications. The NSQIP data show a gap in knowledge translation to clinical practice and highlight the need for improved clinical guidelines. LEVEL OF EVIDENCE: Cohort study; Level III.
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Authors: Codie A Primeau; Trevor B Birmingham; Kristyn M Leitch; Kevin R Willits; Robert B Litchfield; Peter J Fowler; Jacquelyn D Marsh; Bert M Chesworth; Stephanie N Dixon; Dianne M Bryant; J Robert Giffin Journal: CMAJ Date: 2022-03-21 Impact factor: 16.859
Authors: Alan G Shamrock; Zain Khazi; Trevor R Gulbrandsen; Kyle R Duchman; Michael C Willey; Matthew D Karam; Matthew H Hogue; J Lawrence Marsh Journal: Arthrosc Sports Med Rehabil Date: 2020-09-12
Authors: Codie A Primeau; Trevor B Birmingham; Kristyn M Leitch; Kevin R Willits; Robert B Litchfield; Peter J Fowler; Jacquelyn D Marsh; Bert M Chesworth; Stephanie N Dixon; Dianne M Bryant; J Robert Giffin Journal: CMAJ Date: 2021-02-01 Impact factor: 8.262
Authors: Jordan R Pollock; Jaymeson R Arthur; Jacob F Smith; Tala Mujahed; Joseph C Brinkman; M Lane Moore; Anikar Chhabra Journal: Arthrosc Sports Med Rehabil Date: 2021-08-18
Authors: Jacquelyn D Marsh; Ryan Degen; Trevor B Birmingham; J Robert Giffin; Alan Getgood; Robert Litchfield; Kevin Willits; J Andrew McClure; Blayne Welk Journal: Can J Surg Date: 2022-02-18 Impact factor: 2.089