■半月板撕裂的治疗策略从非手术治疗到手术干预。然而,与非手术治疗失败相关的成本相关结局和患者因素的国家趋势仍然知之甚少.
■描述诊断后2年内半月板撕裂非手术与手术治疗的相关费用,并检查患者特征与手术时机之间的关系。
■横断面研究;证据水平,3.
■本研究使用MarketScan数据库进行。包括在2017年1月1日至12月31日之间诊断为半月板撕裂而没有伴随的膝骨关节炎的患者。主要结果是半月板撕裂相关程序的总成本-包括保险自付额,共同保险,和净保险金-在诊断后的2年内。包括的程序如下:(1)手术-包括半月板切除术或半月板修复;(2)物理治疗;(3)药物-包括非甾体抗炎药,阿片类药物,和对乙酰氨基酚;(4)关节内注射-包括专业费用,透明质酸,和皮质类固醇;(5)影像学;(6)骨科专家的临床访问。患者被分组为接受过早期手术(ES)(诊断后≤3个月),晚期手术(LS)(诊断后>3个月),或者没有手术(NS)。进行多变量逻辑回归以确定早期接受手术和非手术治疗失败的可能性。
■研究人群包括29,924名患者,平均年龄为43.9±12.9岁(ES:n=9507(31.8%);LS:n=2021(6.8%);NS:n=18,396(61.5%))。复杂(36.6%)和内侧(58.8%)的半月板撕裂是最常见的类型和部位。分别。每位患者的平均管理成本为$3835±$4795。与ES组($6759±$5155)相比,NS组的费用较低($1905±$3175),而LS组的成本最高($7649±$5913)(P<.001)。病人是男人,>40年,并且在桶柄或外侧半月板撕裂的情况下,更有可能在早期接受手术。病人是男人,<30年,并且外侧半月板有复杂的撕裂或撕裂,更有可能非手术治疗失败。
■非手术治疗的费用负担最低,应推荐给具有适当适应症的患者。然而,如果手术是必要的,应该早点执行。
UNASSIGNED: Treatment strategies for meniscal tears range from nonoperative management to surgical intervention. However, national trends in cost-related outcomes and patient factors related to the failure of nonoperative management remain poorly understood.
UNASSIGNED: To describe the costs associated with nonoperative versus operative management of meniscal tears in the 2 years after diagnosis and examine the relationship between patient characteristics and timing of surgery.
UNASSIGNED: Cross-sectional study; Level of evidence, 3.
UNASSIGNED: This study was conducted using the MarketScan databases. Patients diagnosed with a meniscal tear without concomitant knee osteoarthritis between January 1 and December 31, 2017, were included. The primary outcome was the total cost of meniscal tear-related procedures-including insurance deductibles, coinsurance, and net insurance payments-in the 2 years after diagnosis. Procedures included were as follows: (1) surgery-including meniscectomy or meniscal repair; (2) physical therapy; (3) medication-including nonsteroidal anti-inflammatories, opioids, and acetaminophen; (4) intra-articular injections-including professional fee, hyaluronic acid, and corticosteroids; (5) imaging; and (6) clinic visits to orthopaedic specialists. Patients were grouped as having undergone early surgery (ES) (≤3 months of diagnosis), late surgery (LS) (>3 months after diagnosis), or no surgery (NS). Multivariate logistic regression was performed to determine the likelihood of undergoing surgery early and failing nonoperative treatment.
UNASSIGNED: The study population included 29,924 patients with a mean age of 43.9 ± 12.9 years (ES: n = 9507 (31.8%); LS: n = 2021 (6.8%); NS: n = 18,396 (61.5%)). Complex (36.6%) and medial (58.8%) meniscal tears were the most common type and location of injuries, respectively. The mean cost of management per patient was $3835 ± $4795. Costs were lower in the NS group ($1905 ± $3175) compared with the ES group ($6759 ± $5155), while the highest costs were observed in the LS group ($7649 ± $5913) (P < .001). Patients who were men, >40 years, and with a bucket-handle or lateral meniscal tear were more likely to undergo surgery early. Patients who were men, <30 years, and with a complex tear or tear to the lateral meniscus were more likely to fail nonoperative management.
UNASSIGNED: Nonoperative management had the lowest cost burden and should be recommended for patients with appropriate indications. However, if surgery is necessary, it should be performed earlier.