前瞻性方法导致儿童前交叉韧带重建术后并发症报告率升高
简介
该研究利用前瞻性质量改进登记系统（SCORE数据库）评估儿童前交叉韧带重建术（ACLR）术后8个月内并发症发生率，并与非前瞻性数据库（ABOS数据库）及不同年资医生进行比较。共纳入SCORE数据库8516例患儿（≤18岁），其中992例（11.6%）出现并发症，与ABOS数据库总并发症发生率（11.1%）无显著差异。但前瞻性数据库报告的僵硬（4.8% vs …
英文摘要
BACKGROUND: The incidence of pediatric anterior cruciate ligament reconstructions (ACLR) has drastically increased over the last 20 years. Previous studies have sought to characterize postoperative complications, but few have utilized a prospective, surgeon-reported protocol. This study aimed to utilize a large, multicenter, prospective collection from a quality improvement registry to determine complication incidence ≤8 months after ACLR. Additional aims sought to compare complication rates between the prospective database and a non-prospective database, as well as between early-career (≤5 y) and more experienced surgeons (>5 y). METHODS: This study is a review of complication rates after pediatric ACLR submitted to 2 different collection instruments: the Sports Cohort Outcomes Registry (SCORE), a multicenter, prospective quality improvement registry, and the American Board of Orthopaedic Surgeons (ABOS) Part II Oral Exam database. Patients within the SCORE database underwent surgery from 2018 to 2025 and were ≤18 years old at the time of surgery, while ABOS patients underwent surgery from 2000 to 2021 and were ≤19 years old. Frequencies of complications were calculated, and statistical analysis followed using χ2 and Fisher's exact tests. Additional comparisons were performed based on surgeon experience. Significance was set at P<0.05. RESULTS: Out of 8516 total cases in the SCORE database, 992 (11.6%) experienced a complication ≤8 months post-operation, and there was no significant difference between SCORE and ABOS incidence of total complications (11.6% vs. 11.1%, P=0.2296) (SCORE % vs. ABOS %, P value). In addition, there were no differences in medical complications (0.8% vs. 0.9%, P=0.2182), surgical complications (10.8% vs. 10.1%, P=0.0777), and infection (1.3% vs. 1.5%, P=0.2023). The most common complication, stiffness, had significant differences in reported rates between SCORE and ABOS (4.8% vs. 3.6%, P=0.0013). Differences were also noted in reoperation (3.7% vs. 1.8%, P<0.0001), wound-healing delay (1.3% vs. 0.5%, P<0.0001), pain (1.2% vs. 0.4%, P<0.0001), nerve palsy (1.0% vs. 0.7%, P=0.0325), readmission (0.6% vs. 1%, P=0.0047), and deep vein thrombosis (0.1% vs. 0.2%, P=0.0119). Further analysis of SCORE surgeons with >5 years of experience versus SCORE surgeons with ≤5 years of experience yielded no differences among any complications. In addition, significant differences were no longer found for only DVT (0% vs. 0.2%, P=0.6247) and nerve palsy (0.3% vs. 0.7%, P=0.3281) when comparing SCORE surgeons with ≤5 years of experience versus ABOS surgeons. CONCLUSION: This study provides the first comprehensive list of complications after pediatric ACLR with a large, entirely pediatric, and prospective patient cohort. In addition, it provides the first statistical comparison between pediatric ACLR complications as reported by a prospective database versus a non-prospective database and finds that prospective studies may allow for more accurate determination of reoperation rates and surgical-related complication rates, such as pain, stiffness, and wound-healing delay. In addition, this study provides evidence that complication rates after ACLR do not differ between early-career (≤5 y) and more experienced (>5 y) surgeons.