This article is more than 5 years old. Information may no longer be current.
Study: Meniscectomy is safe for carefully selected older patients
Click Here to Manage Email Alerts
Results of a recently published study support the safety of meniscectomy in older patients and indicated that, regardless of age, patients with a history of smoking or an increased comorbidity burden showed a higher of adverse events or readmission.
“[Meniscectomy] is not a particularly large surgery, but even these surgeries can be associated with general health complications such as heart attacks, pneumonia, readmission, etcetera,” study investigator Jonathan N. Grauer, MD, an associate professor of orthopedics at Yale University School of Medicine, told Orthopedics Today. “However, when we looked at meniscectomies, we did not find that older patients were having worse general health adverse events.”
Low rates of adverse events
Using the American College of Surgeons National Surgical Quality Improvement Program database, Grauer and his colleagues identified 17,774 patients who underwent arthroscopic meniscectomy between 2005 and 2012. Of these patients, 3,420 were aged 65 years or older. The researchers evaluated medical comorbidities as risk factors for readmission and minor, severe or any adverse events. Minor adverse events (MAEs) included renal insufficiency, pneumonia, wound dehiscence or urinary tract infection. Serious adverse events (SAEs) were defined as occurrences such as death, unplanned intubation, stroke, cardiac arrest, myocardial infarction, wound-related infection, sepsis, return to OR, coma, or need for a ventilator. The researchers also analyzed whether any adverse event (AAE), defined as an MAE or SAE, occurred.
Patients in the study had a mean age of 53 ± 13.6 years. Overall, 1.17% of patients experienced an AAE; 0.13% had an MAE; 1.14% experienced an SAE and 0.97% of patients were readmitted.
Smoking and comorbidities
According to multivariate logistic regression analyses, researchers found no significant differences between patients aged 65 years or older compared with younger patients for the occurrence of AAE, MAEs, SAEs or readmission. Younger patients had rates of AAE, SAE and MAE of 1.16%, 1.14%, and 0.09%, respectively. In the younger group, 0.89% were readmitted within 30 days of their index procedure. Among patients aged 65 years and older, rates of AAE, SAE and MAE of 1.23%, 1.17%, and 0.29%, respectively. In this group, 1.29% were readmitted.
The investigators also found patients with an American Society of Anesthesiologists classification of 3 or higher had an increased odds of AAE, SAEs and readmission (1.58, 1.59 and 1.99, respectively). Patients with diabetes had increased odds of AAE and SAEs (1.57 and 1.51, respectively), and patients with pulmonary disease had a 1.76 times higher odds of an AAE and 1.70 times higher odds for an SAE. Patients who were smokers had 1.67 increased odds of readmission.
“We were a little surprised that there were as many older patients getting meniscectomy as we saw,” Grauer said. “We would not have been surprised to see general health outcomes worse in that population, so it was reassuring not to see increased general health complications in the older patient cohort.” – by Casey Tingle
Reference:
Basques BA, et al. AM J Sports Med. 2014;doi:10.1177/0363546514551923.
For more information:
Jonathan N. Grauer, MD, can be reached at Yale School of Medicine, 800 Howard Ave., New Haven, CT 06510; email: jonathan.grauer@yale.edu.
Disclosure: Grauer reports no relevant financial disclosures.