英国牛津大学Jonathan L Rees团队研究了肩关节镜手术后严重不良事件发生率和再手术的风险。该研究于2022年7月6日发表在《英国医学杂志》上。

该研究旨在为临床医生和患者提供常规择期肩关节镜手术（包括一年内再次手术）后严重不良事件的准确风险评估。

研究组使用英国国家医疗服务体系的医院事件统计，包括国家统计局的民事登记死亡率数据。2009年4月1日至2017年3月31日，261248例年龄≥16岁的患者接受了288250次关节镜下肩关节手术治疗。择期手术分为肩峰下减压、肩袖修复、肩锁关节切除、盂肱稳定和冻结肩松解。

主要结局是术后90天内需要住院治疗的严重不良事件（死亡、肺栓塞、肺炎、心肌梗死、急性肾损伤、中风和尿路感染）的发生率。次要结局是90天的特定不良事件发生率，以及一年内再次手术（包括深部感染）。

肩关节镜手术（包括再次手术）后90天内的总并发症发生率较低，为1.2%，相当于每81例患者中有1例存在风险，并且根据手术类型而有所不同，从盂肱稳定术的0.6%到冻结肩松解术的1.7%不等。对年龄、合并症和性别进行校正后，未观察到手术类型的影响。

肺炎是最常见的不良事件（0.3%），相当于每303名患者中就有1名患者存在风险。肺栓塞事件罕见，发生率为0.1%，相当于每1428例患者中有1例存在风险。一年后，再次手术的总发生率为3.8%，相当于每26名患者中就有一名患者存在风险，从盂肱稳定术的2.7%到冻结肩松解术的5.7%不等。

深度感染致再次手术的总发生率较低，为0.1%，相当于每1111例患者中有1例存在风险，但肩袖修复术后再次手术率更高（0.2%），相当于每526例患者中有1例存在风险。在研究期间，关节镜下肩部手术的数量增加，但肩峰下减压术的数量减少。

研究结果表明，与普通肩关节镜手术相关的严重不良事件风险较低。然而，严重的并发症确实会发生，包括一年内每26名患者中就有一人再次手术的风险。

附：英文原文

Title: Serious adverse event rates and reoperation after arthroscopic shoulder surgery: population based cohort study

Author: Jonathan L Rees, Richard Craig, Navraj Nagra, Mathew Baldwin, Jennifer C E Lane, Andrew Price, David J Beard, Simon Abram, Andrew Judge, Daniel Prieto-Alhambra, Dominic Furniss, Andrew J Carr

Issue&Volume: 2022/07/06

Abstract:

Objective To provide clinicians and patients with accurate risk estimates of serious adverse events after common elective shoulder arthroscopic procedures, including reoperation within one year.

Design Population based cohort study.

Setting Hospital Episode Statistics for NHS England, including civil registration mortality data from the Office for National Statistics.

Participants 288250 arthroscopic shoulder procedures performed in 261248 patients aged ≥16 years between 1 April 2009 and 31 March 2017. Elective procedures were grouped into subacromial decompression, rotator cuff repair, acromioclavicular joint excision, glenohumeral stabilisation, and frozen shoulder release.

Main outcome measures The primary outcomes were rates of serious adverse events (mortality, pulmonary embolism, pneumonia, myocardial infarction, acute kidney injury, stroke, and urinary tract infection) requiring inpatient care within 90 days post-surgery. Secondary outcomes were specific adverse event rates at 90 days, and reoperations (including for deep infection) within one year.

Results The overall rate of complications within 90 days after arthroscopic shoulder surgery (including reoperation) was low at 1.2% (95% confidence interval 1.2% to 1.3%), with one in 81 patients at risk, and varied according to type of procedure, from 0.6% (0.5% to 0.8%) for glenohumeral stabilisation to 1.7% (1.5% to 1.8%) for frozen shoulder release. After adjustment for age, comorbidities, and sex, no effect of procedure type was observed. Pneumonia was the most common adverse event (0.3%, 0.3% to 0.4%), with one in 303 patients at risk. Pulmonary embolic events were rare, at 0.1% (0.1% to 0.1%), with one in 1428 patients at risk. At one year, the overall rate for reoperation was 3.8% (3.8% to 3.9%), with one in 26 patients at risk, ranging from 2.7% (2.5% to 3.0%) for glenohumeral stabilisation to 5.7% (5.4% to 6.1%) for frozen shoulder release. The overall rate of further surgery for deep infection was low, at 0.1% (0.1% to 0.1%), with one in 1111 patients at risk, but was higher after rotator cuff repair (0.2%, 0.2% to 0.2%), with one in 526 patients at risk. Over the study period the number of arthroscopic shoulder procedures increased, except for subacromial decompression, which decreased.

Conclusions The findings of this study suggest that risks of serious adverse events associated with common shoulder arthroscopy procedures are low. Nevertheless, serious complications do occur, and include the risk of reoperation in one in 26 patients within one year.

DOI: 10.1136/bmj-2021-069901

Source: https://www.bmj.com/content/378/bmj-2021-069901