PDF(Pubmed)
Abstract：
UNASSIGNED: Elbow ulnar collateral ligament (UCL) reconstruction (UCLR) is the gold standard for operative treatment of UCL tears, with renewed interest in UCL repairs.
UNASSIGNED: To (1) assess trends in rates of UCLR and UCL repair and (2) identify predictors of complications by demographic, socioeconomic, or surgical center volume factors.
UNASSIGNED: Descriptive epidemiology study.
UNASSIGNED: Patients who underwent UCLR or UCL repair at New York State health care facilities between 2010 and 2019 were retrospectively identified; concomitant ulnar nerve procedures among the cohort were also identified. Surgical center volumes were classified as low (<99th percentile) or high (≥99th percentile). Patient information, neighborhood socioeconomic status quantified using the Area Deprivation Index, and complications within 90 days were recorded. Poisson regression analysis was used to compare trends in UCLR versus UCL repair. Multivariable regression was used to determine whether center volume, demographic, or socioeconomic variables were independent predictors of complications.
UNASSIGNED: A total of 1448 UCL surgeries were performed, with 388 (26.8%) concomitant ulnar nerve procedures. UCLR (1084 procedures; 74.9%) was performed more commonly than UCL repair (364 procedures; 25.1%), with patients undergoing UCL repair more likely to be older, female, and not privately ensured and having undergone a concomitant ulnar nerve procedure (all P < .001). With each year, there was an increased incidence rate ratio for UCL repair versus UCLR (β = 1.12 [95% CI, 1.02-1.23]; P = .022). The authors identified 2 high-volume centers (720 UCL procedures; 49.7%) and 131 low-volume centers (728 UCL procedures; 50.3%). Patients undergoing UCL procedures at high-volume centers were more likely to be younger and male and receive workers\' compensation (all P < .001). UCL repair and ulnar nerve-related procedures were both more commonly performed at low-volume centers (P < .001). There were no significant differences in 3-month infection, ulnar neuritis, instability, arthrofibrosis, heterotopic ossification, or all-cause complication rates between low- and high-volume centers. The only significant predictor for all-cause complication was Medicaid insurance (OR, 2.91 [95% CI, 1.20-6.33]; P = .011).
UNASSIGNED: A rising incidence of UCL repair compared with UCLR was found in New York State, especially among female patients, older patients, and nonprivate payers. There were no differences in 3-month complication rates between high- and low-volume centers, and Medicaid insurance status was a predictor for overall complications within 90 days of operation.
UNASSIGNED: To (1) assess trends in rates of UCLR and UCL repair and (2) identify predictors of complications by demographic, socioeconomic, or surgical center volume factors.
UNASSIGNED: Descriptive epidemiology study.
UNASSIGNED: Patients who underwent UCLR or UCL repair at New York State health care facilities between 2010 and 2019 were retrospectively identified; concomitant ulnar nerve procedures among the cohort were also identified. Surgical center volumes were classified as low (<99th percentile) or high (≥99th percentile). Patient information, neighborhood socioeconomic status quantified using the Area Deprivation Index, and complications within 90 days were recorded. Poisson regression analysis was used to compare trends in UCLR versus UCL repair. Multivariable regression was used to determine whether center volume, demographic, or socioeconomic variables were independent predictors of complications.
UNASSIGNED: A total of 1448 UCL surgeries were performed, with 388 (26.8%) concomitant ulnar nerve procedures. UCLR (1084 procedures; 74.9%) was performed more commonly than UCL repair (364 procedures; 25.1%), with patients undergoing UCL repair more likely to be older, female, and not privately ensured and having undergone a concomitant ulnar nerve procedure (all P < .001). With each year, there was an increased incidence rate ratio for UCL repair versus UCLR (β = 1.12 [95% CI, 1.02-1.23]; P = .022). The authors identified 2 high-volume centers (720 UCL procedures; 49.7%) and 131 low-volume centers (728 UCL procedures; 50.3%). Patients undergoing UCL procedures at high-volume centers were more likely to be younger and male and receive workers\' compensation (all P < .001). UCL repair and ulnar nerve-related procedures were both more commonly performed at low-volume centers (P < .001). There were no significant differences in 3-month infection, ulnar neuritis, instability, arthrofibrosis, heterotopic ossification, or all-cause complication rates between low- and high-volume centers. The only significant predictor for all-cause complication was Medicaid insurance (OR, 2.91 [95% CI, 1.20-6.33]; P = .011).
UNASSIGNED: A rising incidence of UCL repair compared with UCLR was found in New York State, especially among female patients, older patients, and nonprivate payers. There were no differences in 3-month complication rates between high- and low-volume centers, and Medicaid insurance status was a predictor for overall complications within 90 days of operation.
摘要：
■肘部尺侧副韧带（UCL）重建（UCLR）是手术治疗UCL眼泪的金标准，对UCL维修重新产生兴趣。
■（1）评估UCLR和UCL修复率的趋势，（2）通过人口统计学确定并发症的预测因素，社会经济,或手术中心体积因素。
■描述性流行病学研究。
在2010年至2019年期间在纽约州医疗机构接受UCLR或UCL修复的患者进行了回顾性鉴定；还确定了队列中伴随的尺神经手术。手术中心容积分为低(<第99百分位数)或高(≥第99百分位数)。患者信息,使用区域剥夺指数量化的邻里社会经济地位，记录90天内的并发症。使用泊松回归分析比较UCLR与UCL修复的趋势。多变量回归用于确定中心体积，人口统计学,或社会经济变量是并发症的独立预测因子.
■共进行了1448例UCL手术，388例（26.8%）伴随尺神经手术。UCLR（1084例手术；74.9%）比UCL修复（364例手术；25.1%）更常见，接受UCL修复的患者年龄更大，女性,并且没有私下保证，并且经历了伴随的尺神经手术（所有P<.001）。每一年,UCL修复与UCLR的发生率比率增加(β=1.12[95%CI,1.02-1.23];P=0.022).作者确定了2个高容量中心（720个UCL程序；49.7％）和131个低容量中心（728个UCL程序；50.3％）。在高容量中心接受UCL手术的患者更有可能是年轻和男性，并获得工人补偿(所有P<.001)。UCL修复和尺神经相关手术均在低容量中心进行（P<.001）。3个月感染无显著差异,尺神经炎,不稳定性,关节纤维化，异位骨化,或低容量和高容量中心之间的全因并发症发生率。全因并发症的唯一显著预测因素是医疗补助保险(OR，2.91[95%CI，1.20-6.33]；P=.011）。
■在纽约州，与UCLR相比，UCL修复的发生率上升，尤其是女性患者，老年患者,非私人付款人。高容量和低容量中心的3个月并发症发生率没有差异，医疗补助保险状况是手术后90天内总体并发症的预测指标。
■（1）评估UCLR和UCL修复率的趋势，（2）通过人口统计学确定并发症的预测因素，社会经济,或手术中心体积因素。
■描述性流行病学研究。
在2010年至2019年期间在纽约州医疗机构接受UCLR或UCL修复的患者进行了回顾性鉴定；还确定了队列中伴随的尺神经手术。手术中心容积分为低(<第99百分位数)或高(≥第99百分位数)。患者信息,使用区域剥夺指数量化的邻里社会经济地位，记录90天内的并发症。使用泊松回归分析比较UCLR与UCL修复的趋势。多变量回归用于确定中心体积，人口统计学,或社会经济变量是并发症的独立预测因子.
■共进行了1448例UCL手术，388例（26.8%）伴随尺神经手术。UCLR（1084例手术；74.9%）比UCL修复（364例手术；25.1%）更常见，接受UCL修复的患者年龄更大，女性,并且没有私下保证，并且经历了伴随的尺神经手术（所有P<.001）。每一年,UCL修复与UCLR的发生率比率增加(β=1.12[95%CI,1.02-1.23];P=0.022).作者确定了2个高容量中心（720个UCL程序；49.7％）和131个低容量中心（728个UCL程序；50.3％）。在高容量中心接受UCL手术的患者更有可能是年轻和男性，并获得工人补偿(所有P<.001)。UCL修复和尺神经相关手术均在低容量中心进行（P<.001）。3个月感染无显著差异,尺神经炎,不稳定性,关节纤维化，异位骨化,或低容量和高容量中心之间的全因并发症发生率。全因并发症的唯一显著预测因素是医疗补助保险(OR，2.91[95%CI，1.20-6.33]；P=.011）。
■在纽约州，与UCLR相比，UCL修复的发生率上升，尤其是女性患者，老年患者,非私人付款人。高容量和低容量中心的3个月并发症发生率没有差异，医疗补助保险状况是手术后90天内总体并发症的预测指标。
