Purpose
The aims of this study were to quantify the frequency of adverse outcomes after elective
knee arthroscopies in Victoria, Australia, and to identify risk factors associated
with adverse outcomes.
Methods
We performed a retrospective, longitudinal cohort study of elective orthopaedic admissions
using the Victorian Admitted Episodes database, a routinely collected public and private
hospital episodes database linked to death registry data, from July 1, 2000, to June
30, 2009. Adverse outcome measures included pulmonary embolism (PE), deep vein thrombosis
(DVT), hemarthrosis, effusion and synovitis, cellulitis, wound infection, synovial
fistula, acute renal failure, myocardial infarct, stroke, and death. Patients were
excluded if they had an additional procedure performed during the arthroscopy admission.
We identified complications during the admission and within readmissions up to 30
days after the procedure. PE, DVT, and death within 90 days of the arthroscopy episode
were also examined. We used logistic regression analysis to identify risk factors
associated with complications.
Results
After we excluded 16,807 patients (8.5%) with an additional procedure during their
admission, there were 180,717 episodes involving an elective arthroscopy during the
period studied. The most common adverse outcomes within 30 days were DVT (579, 0.32%),
effusion and synovitis (154, 0.09%), PE (147, 0.08%), and hemarthrosis (134, 0.07%).
The 30-day orthopaedic readmission rate was 0.77%, and there were 55 deaths (0.03%).
Within 90 days of arthroscopy, we identified 655 events of DVT (0.36%) and 179 PE
events (0.10%). Logistic regression analysis identified that potential risk factors
for complications were older age, presence of comorbidity, being married, major mechanical
issues, and having the procedure performed in a public hospital.
Conclusions
Our study found 6.4 adverse outcomes per 1,000 elective knee arthroscopy procedures
(0.64%), with the 3 most common complications being DVT, effusion and synovitis, and
PE. We have also identified risk factors for adverse outcomes, particularly chronic
kidney disease, myocardial infarction, cerebrovascular accident, and cancer.
Level of Evidence
Level III, retrospective cohort study.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Complications of arthroscopy of the knee.J Bone Joint Surg Br. 2002; 84: 937-945
- Symptomatic pulmonary embolism after outpatient arthroscopic procedures of the knee: The incidence and risk factors in 418,323 arthroscopies.J Bone Joint Surg Br. 2011; 93: 47-51
- Incidence of symptomatic venous thromboembolism after elective knee arthroscopy.J Bone Joint Surg Am. 2012; 94: 714-720
- The burden of arthroscopy of the knee: A contemporary analysis of data from the English NHS.J Bone Joint Surg Br. 2011; 93: 1327-1333
- The Victorian Admitted Episodes Dataset: An overview.Victorian Department of Human Services Acute Health Division, Melbourne2001
- Quality of diagnosis and procedure coding in ICD-10 administrative data.Med Care. 2006; 44: 1011-1019
- Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.Med Care. 2005; 43: 1130-1139
- The performance of different lookback periods and sources of information for Charlson comorbidity adjustment in Medicare claims.Med Care. 1999; 37: 1128-1139
- Technical paper census of population and housing: Socio-Economic Indexes for Area's (SEIFA), Australia, 2001.Australian Bureau of Statistics, Canberra2004
- Prevention of VTE in orthopaedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.Chest. 2012; 141: e278S-e325S
- NICE clinical guideline 49. Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery.National Institute for Health and Clinical Excellence, London2010
- Clinical practice guideline for the prevention of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to Australian hospitals.National Health and Medical Research Council, Melbourne2009
- Interventions for preventing venous thromboembolism in adults undergoing knee arthroscopy.Cochrane Database Syst Rev. 2008; : CD005259
- Low-molecular-weight heparin versus compression stockings for thromboprophylaxis after knee arthroscopy: A randomized trial.Ann Intern Med. 2008; 149: 73-82
- Chronic kidney disease and venous thromboembolism: Epidemiology and mechanisms.Curr Opin Pulm Med. 2009; 15: 408-412
- Cancer and thrombosis: Implications of published guidelines for clinical practice.Ann Oncol. 2009; 20: 1619-1630
- Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States Medicare population.J Bone Joint Surg Am. 2001; 83: 1622-1629
- The relationship between surgeon and hospital volume and outcomes for shoulder arthroplasty.J Bone Joint Surg Am. 2004; 86: 496-505
- The new health insurance rebate: An inefficient way of assisting public hospitals.Med J Aust. 2000; 172: 439-442
- A controlled trial of arthroscopic surgery for osteoarthritis of the knee.N Engl J Med. 2002; 347: 81-88
- A randomized trial of arthroscopic surgery for osteoarthritis of the knee.N Engl J Med. 2008; 359: 1097-1107
- Length of comorbidity lookback period affected regression model performance of administrative health data.J Clin Epidemiol. 2006; 59: 940-946
Article info
Publication history
Published online: February 08, 2013
Accepted:
November 15,
2012
Received:
May 30,
2012
Footnotes
The authors report the following potential source of funding in relation to this article: Arthritis Australia. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of this manuscript.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
