2015 ISAKOS Biennial Congress ePoster #502
Demographic Trends and Complication Rates in Arthroscopic Elbow Surgery
Natalie Luanne Leong, MD, Los Angeles, CA UNITED STATES
Jeremiah R. Cohen, BS, Los Angeles, CA UNITED STATES
Elizabeth Lord, MD, Los Angeles, CA UNITED STATES
Jeffrey C. Wang, MD, Santa Monica, CA UNITED STATES
David R. McAllister, MD, Los Angeles, CA UNITED STATES
Frank A. Petrigliano, MD, Los Angeles, CA UNITED STATES
University of California, Los Angeles, Los Angeles, California, USA
FDA Status Not Applicable
Summary: In this study utilizing a large private insurance database, demographic trends in elbow arthroscopy and the frequency of complications requiring reoperation in arthroscopic elbow surgery are explored.
Since its advent in the 1980s, elbow arthroscopy has become a more common procedure. However, little is known about the demographic trends and complication rates associated with these surgeries.
The Current Procedural Terminology (CPT) billing codes of patients undergoing elbow arthroscopy were searched using a national insurance database. From 2007 to 2011, over 20 million patient records were present in the database with an orthopaedic International Classification of Disease, Ninth Revision (ICD-9) diagnosis code or CPT code. Elbow procedures searched included diagnostic arthroscopy, loose body removal, synovectomy, and debridement. The incidence of reoperation for infection, stiffness, and nerve injury was examined.
A total of 6,287 unique records of patients undergoing arthroscopic elbow surgery were identified within the 5-year period from 2007 to 2011. There was a statistically significant increase in the incidence of elbow arthroscopic procedures over time, from 1.27 in 10,000 orthopaedic patients in 2007 to 1.45 in 10,000 in 2011 (p = 0.01, r=0.808). Males accounted for 74% of patients undergoing these procedures. Forty-seven percent of elbow arthroscopy patients were 40-59 years old. The database is most well represented by the South (45.8% of orthopaedic patients), whereas the Northeast has the smallest representation (12.8%). With all arthroscopic elbow procedures combined, the observed distribution of procedures by region was as expected. In all procedures, other than synovectomy, statistically significant regional differences were observed (p = 0.001). For diagnostic elbow arthroscopy, the number of procedures performed in the South was 23% more than expected, while 31% fewer than expected were performed in the Northeast. For loose body removal, 27% more procedures were performed than expected in the West, while 19% fewer than expected were observed in the Northeast. The overall rate of re-operation was 2.2%, with a specific rate of 0.26% for infection, 0.63% for stiffness, and 1.26% for nerve injury.
Overall, the incidence of elbow arthroscopy in this patient population was low, and increased slightly over time. Furthermore, the rate of complication requiring re-operation was very low at 2.2%, with nerve exploration being the most common re-operation performed. There exist a number of obvious limitations to this study. This database does not provide a representative sample of the entire American population. In addition, patient-specific information was unavailable. Also, data regarding regional differences in potential confounding factors such as body mass index and smoking habits was not available, and the results are subject to error introduced by improper coding. With regards to the complication rates, it is difficult to assess the rate of complications not requiring operative intervention. Nevertheless, these limitations are inherent in most database studies, and should not negate the important demographic information that can be gleaned from this study. The information gleaned from this study may be useful in counseling patients on the likelihood of complications following arthroscopic elbow surgery. These data may also be applied to the evaluation of newly adapted practices and technologies.