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Epidemiology of Surgical Treatment of Adolescent Sports Injuries in the United States: Analysis of the MarketScan Commercial Claims and Encounters Database.

ABSTRACT: Purpose:To determine whether there is increasing surgical management of adolescent sports injuries and whether the average age of surgical patients is decreasing. Methods:The Truven Health MarketScan Database was searched from 2008 to 2014 for patients 10 to 19 years of age using the International Classification of Disease, 9th Revision codes and Current Procedure Terminology, 4th Edition, codes for operative treatment for the following conditions: anterior cruciate ligament (ACL) injuries, knee collateral ligament (KCL) injuries, meniscal injuries, Osgood-Schlatter syndrome, and elbow ulnar collateral ligament injuries. Patients identified were characterized by sex, age, year of injury, and type of residence (urban vs rural) based on metropolitan statistical areas. Results:A total of 516,892 patients sustained 1 of the identified injuries, and 133,541 (25.8%) patients underwent a related surgery. KCL and meniscal injuries demonstrated a consistent increase in the rate of surgical intervention (P < .0001). Average age of surgical intervention did not increase or decrease overall for any diagnosis. Female adolescents were more likely to undergo surgery for KCL injuries (adjusted odds ratio [aOR] 1.7, 95% confidence interval [CI] 1.58-1.79, P < .0001), Osgood-Schlatter syndrome (aOR 1.8, 95% CI 1.38-2.39, P < .0001), and ACL injuries (aOR 1.5, 95% CI 1.45-1.52, P < .0001), whereas male adolescents were more likely to undergo surgery for meniscal injuries (aOR 1.3, 95% CI 1.24-1.30, P < .0001) and ulnar collateral ligament injuries (aOR 1.1, 95% CI 1.06-1.23, P < .0005). Patients in rural areas were more likely to undergo surgical intervention for ACL and meniscal injuries (P < .0001) and KCL injuries (P = .02). Conclusions:We found that surgical treatment of 5 common sports injuries remains stable, with only KCL injuries and meniscal injuries showing an increase in surgical incidence. Average age of surgical intervention did not change significantly over the 7-year time span for any diagnosis. Level of Evidence:Level IV, Cross Sectional Study.

SUBMITTER: Bonazza N

PROVIDER: S-EPMC7120859 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Epidemiology of Surgical Treatment of Adolescent Sports Injuries in the United States: Analysis of the MarketScan Commercial Claims and Encounters Database.

Bonazza Nicholas N Smuin Dallas M DM Sterling Nicholas N Ba Djibril D Liu Guodong G Leslie Douglas L DL Hennrikus William W Dhawan Aman A

Arthroscopy, sports medicine, and rehabilitation 20191001 1

<h4>Purpose</h4>To determine whether there is increasing surgical management of adolescent sports injuries and whether the average age of surgical patients is decreasing.<h4>Methods</h4>The Truven Health MarketScan Database was searched from 2008 to 2014 for patients 10 to 19 years of age using the <i>International Classification of Disease, 9th Revision</i> codes and Current Procedure Terminology, 4th Edition, codes for operative treatment for the following conditions: anterior cruciate ligamen ...[more]

PMID: 32266341

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Project description:Purpose:To evaluate trends in procedures for the treatment of chondral injuries of the knee using the MarketScan database in the hope that further work can be performed to refine the indications for chondral intervention. Methods:The MarketScan Research Database was searched using Current Procedure Terminology, 4th edition, codes to identify patients who underwent chondral procedures of the knee from 2005-2014. Combined procedures, including meniscal transplant or osteotomy, were also identified. Patients were characterized by gender, age group and year of initial procedure. A ?2 test was used to evaluate differences in surgical trends between individual patient groups delineated by age and gender. The Cochran-Armitage trend test was used to identify significant differences in surgical trends yearly. Results:Of 148,373,254 unique patients, 520,934 patients underwent a total of 599,119 procedures. Arthroscopy with debridement/shaving of articular cartilage decreased in proportion from 75% of all procedures in 2005 to 51% of all procedures in 2014 (P < .0001). Open osteochondral allograft saw the greatest change during the study period; a higher number of females than males underwent condral procedures (P < .0001). Patients aged 45-54 underwent the most procedures (32.9% of all procedures). A total of 483 patients underwent chondral procedures in conjunction with meniscal transplant with variable incidence during the study period. A total of 1,418 patients underwent chondral procedures in conjunction with osteotomy; cumulative incidence decreased from 4.5 procedures per 1,000,000 patients/year in 2005 to 2.6 procedures per 1,000,000 patients/year in 2014 (P < .0001). Conclusions:Knee arthroscopy with debridement/shaving of articular cartilage remains the most common procedure performed. Although open allograft and autograft transplantation saw a sustained increase in incidence, the overall incidence of cartilage procedures, as well as those performed with osteotomies, declined. Level of Evidence:Level IV, cross-sectional study.

Project description:BackgroundNumerous studies have demonstrated an increase in the number of anterior cruciate ligament (ACL) reconstruction procedures performed in pediatric patients. Despite this, most knowledge of surgical site infection rates after these procedures are based on adult studies and data is currently limited in pediatric patients. The purpose of this study was to describe and analyze the rates of infection after ACL reconstruction among pediatric patients and adolescent patients (compared with young adult patients) utilizing the MarketScan Commercial Claims and Encounters Database.MethodsThe Truven Health Analytics MarketScan Commercial Claims and Encounters database was assessed to access health care utilization data for privately insured individuals aged 5 to 30 years old. ACL reconstruction records performed between 2006 and 2018 were identified using Current Procedures Terminology (CPT) codes. International Classification of Diseases Ninth Revision (ICD-9), Tenth (ICD-10) codes and CPT codes were used to identify patients requiring treatment for infection. All patients had at least 180 days of insurance coverage after intervention.ResultsA total of 44,501 individuals aged below 18 years old and 63,495 individuals aged 18 to 30 years old that underwent arthroscopic ACL reconstruction were identified. There were no differences in infection rates between those below 18 years old (0.52%) and those above 18 years old (0.46%, P=0.227). However, among patients below 18 years old, patients below 15 years old had a significantly lower rate of infection at 0.37% compared with adolescents (15 to 17 y old) at 0.55% (P=0.039). Among young adults, males had higher rates of infection than females (0.52% vs. 0.37%), while no difference was observed in the pediatric and adolescent population (0.58% vs. 0.47%, P=0.109).ConclusionUtilizing an insurance database, this study demonstrated that rates of infection after ACL Reconstruction in a pediatric/adolescent population are low (0.52%) and similar to rates in young adults. Infection rates after ACLR reconstruction appear to be slightly lower in patients under 15 years of age (0.37%).Level of evidenceLevel III-Retrospective comparative study.

Dataset Information

Epidemiology of Surgical Treatment of Adolescent Sports Injuries in the United States: Analysis of the MarketScan Commercial Claims and Encounters Database.

Publications

Epidemiology of Surgical Treatment of Adolescent Sports Injuries in the United States: Analysis of the MarketScan Commercial Claims and Encounters Database.

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