RESUMO
OBJECTIVE: This retrospective propensity score-matched cohort study aimed to examine the frequency of acromioplasty among patients with shoulder disorders receiving and not receiving acupuncture, based on Korea National Health Insurance Service-National Sample Cohort (NHIS-NSC) data. METHODS: We included cases of high-frequency shoulder disorders-adhesive capsulitis, rotator cuff syndrome, shoulder impingement syndrome, and sprain and strain of the shoulder joint-stratified from the Korea NHIS-NSC database between 2002 and 2013; cases were classified into two groups based on a history of acupuncture treatment performed at least twice within 6 weeks (acupuncture group: n = 111,561; control group: n = 71,340). We examined propensity scores and hazard ratios (HRs) for the frequency of acromioplasty, within 2 years of the first treatment or first examination in the acupuncture and control groups, respectively; cumulative survival rates were estimated using Kaplan-Meier survival analysis. RESULTS: Following propensity score matching, no differences were observed between the acupuncture and control groups for variables including sex, age, income and the Charlson comorbidity index. In addition, the incidence rates of acromioplasty within 2 years were lower in the acupuncture group than in the control group (HR 0.264; 95% confidence interval 0.224-0.311). Based on differences in sensitivity analyses for the numbers of acupuncture sessions and treatment duration, the frequency of acromioplasty within 2 years was lower in the acupuncture group than in the control group. CONCLUSION: This study found that the frequency of acromioplasty was reduced in patients with shoulder disorders who had been treated with acupuncture. Although the findings need to be verified by prospective randomized clinical trials, these results imply that acupuncture may be effective at reducing the incidence rate of shoulder surgery.
Assuntos
Terapia por Acupuntura , Artroplastia/estatística & dados numéricos , Dor de Ombro/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: Shoulder arthroplasty is being performed in the United States with increasing frequency. We describe the medium-term findings from a large integrated healthcare system shoulder arthroplasty registry. PATIENTS AND METHODS: Shoulder arthroplasty cases registered between January 2005 and June 2013 were included for analysis. The registry included patient characteristics, surgical information, implant data, attrition, and patient outcomes such as surgical site infections, venous thromboembolism, and revision procedures. RESULTS: During the study period, 6,336 primary cases were registered. Median follow-up time for all primaries was 3.3 years; 461 cases were lost to follow-up by ending of health plan membership. Primary cases were predominantly female (56%) and white (81%), with an average age of 70 years. The most common reason for surgery was osteoarthritis in 60% of cases, followed by acute fracture (17%) and rotator cuff tear arthropathy (15%). In elective shoulder arthroplasty procedures, 200 all-cause revisions (4%) were reported, with glenoid wear being the most common reason. INTERPRETATION: Most arthroplasties were elective procedures: over half performed for osteoarthritis. Glenoid wear was the most common reason for revision of primary shoulder arthroplasty in elective cases.
Assuntos
Artroplastia/estatística & dados numéricos , Atenção à Saúde/estatística & dados numéricos , Osteoartrite/cirurgia , Sistema de Registros , Lesões do Manguito Rotador , Fraturas do Ombro/cirurgia , Articulação do Ombro/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia/métodos , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Osteoartrite/epidemiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Manguito Rotador/cirurgia , Fraturas do Ombro/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento , Estados Unidos/epidemiologia , Trombose Venosa/epidemiologiaRESUMO
The efficiency of post-operative cell saving after major joint arthroplasty has been demonstrated in prospective studies focusing on blood management. In everyday practice, however, it is likely that transfusion policy is followed less rigorously because of a slackening in attention to blood management, with a reduced efficiency of post-operative cell saving. The primary research question of this retrospective study was whether the number of allogeneic blood transfusions administered to patients treated with a retransfusion system was similar to the results found in a preceding prospective study. A total of 438 patients treated with the Bellovac ABT retransfusion system were analysed in which the majority was operated on a total hip arthroplasty (THA) and total knee arthroplasty (TKA). The amount of retransfused shed blood, the perioperative haemoglobin levels and the number of allogeneic blood transfusions were registered. The average amount of retransfusion was 152 mL in THA and 410 mL in TKA, whereas the allogeneic blood transfusion rate was 8.4 and 5.1% in both groups, respectively. The average percentage of allogeneic blood transfusions administered in this study (i.e. 7%) proved to be marginally higher than the percentage found in a preceding prospective study (i.e. 6%) because of slackening of attention for transfusion policy in everyday practice. Limited bone resection procedures such as resurfacing THA or unicompartmental knee arthroplasty were associated with very limited shed blood and low risk of allogeneic blood transfusion, indicating the doubtful cost efficiency of using a retransfusion system in these patients. It can be concluded that the efficiency of the retransfusion system in everyday practice was similar to the efficiency shown in a preceding prospective study focusing on blood management. However, continual training of the clinical team is crucial.