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Effect of Operative Time on Short-Term Adverse Events After Isolated Anterior Cruciate Ligament Reconstruction

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Effect of Operative Time on Short-Term Adverse Events After Isolated Anterior Cruciate Ligament Reconstruction

Avinesh Agarwalla et al. Orthop J Sports Med.

Abstract

Background: A longer operative time has been previously recognized as a risk factor for short-term complications after various orthopaedic procedures; however, it has yet to be investigated as an independent risk factor for postoperative complications after anterior cruciate ligament (ACL) reconstruction.

Purpose: To identify whether a longer operative time in ACL reconstruction is an independent risk factor for the development of postoperative complications, hospital readmissions, or an extended length of stay within 30 days of the index procedure.

Study design: Descriptive epidemiology study.

Methods: Patients undergoing ACL reconstruction between 2005 and 2016 were identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Cases with concomitant procedures were excluded from the analysis. We evaluated the association between operative time and preoperative variables such as patient age, sex, body mass index, comorbidities, and procedure. Correlations between adverse events and operative time, while controlling for the above preoperative variables, were calculated using multivariate Poisson regression with robust error variance.

Results: A total of 14,159 procedures were included in this investigation. The mean patient age was 32.6 ± 10.8 years, the mean body mass index was 27.7 ± 6.5 kg/m2, and the mean operative time was 89.7 ± 28.6 minutes. Patients who were between the ages of 18 and 30 years (mean operative time, 95.1 ± 27.8 minutes; relative risk [RR], 17.7; P < .001), male (mean operative time, 91.9 ± 28.3 minutes; RR, 4.7; P < .001), and nondiabetic (mean operative time, 89.8 ± 28.6 minutes; RR, 7.1; P = .011) were associated with a longer operative duration. The overall complication rate was 1.1%. After adjusting for demographic characteristics and procedures, 15-minute incremental increases in operative duration were associated with an increased risk of deep vein thrombosis (RR, 1.12; P = .042), surgical site infections (RR, 1.21; P = .001), and sepsis (RR, 1.66; P < .001) as well as increased readmission rates (RR, 1.23; P = .001) and an extended length of stay (RR, 1.18; P = .008).

Conclusion: While the overall adverse risk rate after ACL reconstruction remains low, marginal increases in operative time are associated with an increased risk of adverse events such as deep vein thrombosis, surgical site infections, sepsis, an extended length of stay, and readmissions. Thus, the operating physician and surgical staff should make all efforts to coordinate and prepare for each case to maximize surgical efficiency.

Keywords: anterior cruciate ligament; complications; deep vein thrombosis; operative time; surgical site infection.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: G.H.G. has received educational support from Smith & Nephew. D.D.B. receives research support from OPED and has received educational support from Medwest Associates. N.N.V. has received research support from Arthrex, Arthrosurface, Athletico, ConMed Linvatec, DJO, Miomed, Mitek, Ossur, and Smith & Nephew; is a consultant for Arthrex, Medacta, Minivasive, and Orthospace; is a paid speaker/presenter for Pacira Pharmaceuticals; has received educational support from Medwest Associates; has stock/stock options in CyMedica, Minivasive, and Omeros; and receives royalties from Smith & Nephew, Arthroscopy, and Vindico Medical (Orthopedics Hyperguide). B.F. receives research support from Arthrex and Stryker, receives fellowship support from Smith & Nephew and Ossur, has received educational support from Medwest Associates, is a consultant for Sonoma Orthopedics and Stryker, has received an honorarium from Arthrosurface, receives royalties from Elsevier, and has stock/stock options in Jace Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Predicted linear correlation between operative time and frequency of adverse events in comparison with the distribution of operative time. Error bars represent 95% confidence intervals.

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