Purpose
To understand the effect of obesity on operative times and 30-day readmission rates
after arthroscopic anterior cruciate ligament reconstruction (ACLR).
Methods
The American College of Surgeons National Surgical Quality Improvement Program database
was queried using Current Procedural Terminology billing codes to identify all patients
aged 18 years and older who underwent ACLR between 2007 and 2014. The Student t test was used for continuous variables, and the χ-square or Fisher exact test was
used for categorical variables. Multivariate analysis was conducted to identify factors
associated with 30-day readmission.
Results
We identified 9,000 patients who underwent ACLR. In the readmission analysis, the
total readmission rate was 0.70%. After multivariate analysis, a body mass index (BMI)
of 40 or greater was associated with a significantly increased risk of 30-day readmission
(odds ratio, 3.06; 95% confidence interval, 1.09-8.57). An operative time of less
than 80 minutes was associated with a decreased risk of readmission (odds ratio, 0.40,
95% confidence interval, 0.18-0.92). In the operative-time analysis, the mean operative
time was 100.7 minutes. Older age was predictive of decreasing operative time, with
the operative time being 32.75 minutes shorter in patients aged 65 years or older
than in those younger than 25 years. After multivariate analysis, class II obesity
(BMI of 35-39.9) predicted an increase of 7.11 minutes and class III obesity (BMI
≥ 40) predicted an increase of 8.70 minutes compared with normal weight (BMI of 18.5-24.9).
Conclusions
Obesity is associated with longer operative times and increased 30-day readmissions
after ACLR, with patients with a BMI of 40 or greater having over 3 times the risk
of readmission compared with patients with a normal weight. Male sex, black race,
and younger age are all also associated with increased operative times.
Level of Evidence
Level III, observational, 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
- Allograft safety in anterior cruciate ligament reconstruction.Clin Sports Med. 2007; 26: 597-605
- Trends in anterior cruciate ligament reconstruction in the United States.Orthop J Sports Med. 2015; 3 (2325967114563664)
- CMS dry run hospital-specific report for hospital-wide all-cause unplanned readmission (HWR) measure.Centers for Medicare & Medicaid Services, Woodlawn, MD2012
- Economic and quality scheduling for effective utilization of operating rooms.J Med Syst. 2012; 36: 1205-1222
- Prevalence of obesity among adults and youth: United States, 2011-2014.NCHS Data Brief. 2015; 219: 1-8
- Prevalence of obesity among patients admitted for elective orthopaedic surgery.Int J Obes Relat Metab Disord. 1994; 18: 709-713
- A review of obesity and orthopaedic surgery: The critical issues.Niger Postgrad Med J. 2012; 19: 175-180
- Thirty-day postoperative complications and mortality following total knee arthroplasty: Incidence and risk factors among a national sample of 15,321 patients.J Bone Joint Surg Am. 2014; 96: 20-26
- The influence of obesity on the complication rate and outcome of total knee arthroplasty: A meta-analysis and systematic literature review.J Bone Joint Surg Am. 2012; 94: 1839-1844
- Bariatric surgery prior to total knee arthroplasty is associated with fewer postoperative complications.J Arthroplasty. 2015; 30: 81-85
- Morbid obesity and excessive hospital resource consumption for unilateral primary hip and knee arthroplasty.J Arthroplasty. 2010; 25: 1258-1266
- Morbid obesity in total hip arthroplasty: Redefining outcomes for operative time, length of stay, and readmission.J Arthroplasty. 2016; 31: 1949-1953
- Factors affecting readmission rates following primary total hip arthroplasty.J Bone Joint Surg Am. 2014; 96: 1201-1209
- Understanding readmission after primary total hip and knee arthroplasty: Who's at risk?.J Arthroplasty. 2014; 29: 256-260
- Obesity and readmission in elderly surgical patients.Surgery. 2012; 152: 355-362
- Body mass index as an indicator of associated intra-articular injuries in patients with anterior cruciate ligament tears.J Surg Orthop Adv. 2015; 24: 159-163
- Predictors of radiographic knee osteoarthritis after anterior cruciate ligament reconstruction.Am J Sports Med. 2011; 39: 2595-2603
- Obesity is associated with poorer range of motion and Tegner scores following hamstring autograft anterior cruciate ligament reconstruction in Asians.Ann Transl Med. 2017; 5: 304
- Weak associations between body mass index and self-reported disability in people with unilateral anterior cruciate ligament reconstruction.Knee Surg Sports Traumatol Arthrosc. 2017; 34: 128
- User guide for the 2012 ACS NSQIP Participant Use Data File.American College of Surgeons, Chicago, IL2013
- Readmission rates, reasons, and risk factors in elderly patients treated with lumbar fusion for degenerative pathology.Spine. 2016; 41: 1933-1938
- Age and obesity are risk factors for adverse events after total hip arthroplasty.Clin Orthop Relat Res. 2012; 470: 490-496
- Impact of increased body mass index on outcomes of elective spinal surgery.Spine. 2014; 39: 1520-1530
- Are there modifiable risk factors for hospital readmission after total hip arthroplasty in a US healthcare system?.Clin Orthop Relat Res. 2015; 473: 3446-3455
- A preoperative scale for determining surgical readmission risk after total hip replacement.JAMA Surg. 2016; 151: 701-709
- Obesity in total hip replacement.J Bone Joint Surg Br. 2008; 90: 424-429
- Complications in total shoulder and reverse total shoulder arthroplasty by body mass index.J Shoulder Elbow Surg. 2017; 26: 1230-1237
- The impact of metabolic syndrome on 30-day complications following total joint arthroplasty.J Arthroplasty. 2017; 32: 362-366
- Is obesity a risk factor for adverse events after knee arthroscopy?.Arthroscopy. 2016; 32: 1346-1353.e1
- Risk factors for short-term complications of anterior cruciate ligament reconstruction in the United States.Am J Sports Med. 2016; 44: 618-624
- Risk factors for thirty-day morbidity and mortality following knee arthroscopy.J Bone Joint Surg Am. 2013; 95 (e98 1-e98 10)
- Shoulder arthroscopy in adults 60 or older: Risk factors that correlate with postoperative complications in the first 30 days.Arthroscopy. 2017; 33: 49-54
- Risk factors for 30-day readmission following shoulder arthroscopy.Arthroscopy. 2017; 33: 55-61
- Outcomes of arthroscopic rotator cuff repairs in obese patients.J Shoulder Elbow Surg. 2011; 20: 961-967
- Knee joint arthroscopy in the morbidly obese.Arthroscopy. 1998; 14: 321-324
- Correlation of obesity with patient-reported outcomes and complications after hip arthroscopy.Arthroscopy. 2015; 31: 57-62
- Longer operative time during benign laparoscopic and robotic hysterectomy is associated with increased 30-day perioperative complications.J Minim Invasive Gynecol. 2015; 22: 1049-1058
- How slow is too slow? Correlation of operative time to complications: An analysis from the Tennessee Surgical Quality Collaborative.J Am Coll Surg. 2015; 220: 550-558
- Prolonged operative time increases infection rate in tibial plateau fractures.Injury. 2013; 44: 249-252
- Prolonged operative time correlates with increased infection rate after total knee arthroplasty.HSS J. 2006; 2: 70-72
- Does operative time affect infection rate in primary total knee arthroplasty?.Clin Orthop Relat Res. 2015; 473: 64-69
- Factors associated with meniscal tears and chondral lesions in patients undergoing anterior cruciate ligament reconstruction: A prospective study.Am J Sports Med. 2013; 41: 2759-2765
- Risk factors for hospital admission after anterior cruciate ligament reconstruction.Arthroscopy. 2017; 33: 1405-1411
- 20 Years of pediatric anterior cruciate ligament reconstruction in New York State.Am J Sports Med. 2014; 42: 675-680
- Injury pathology at the time of anterior cruciate ligament reconstruction associations with self-assessment of knee function.Clin J Sport Med. 2014; 24: 461-467
- Differences in mechanisms of failure, intraoperative findings, and surgical characteristics between single- and multiple-revision ACL reconstructions: A MARS cohort study.Am J Sports Med. 2013; 41: 1571-1578
- Allograft versus autograft anterior cruciate ligament reconstruction: Predictors of failure from a MOON prospective longitudinal cohort.Sports Health. 2011; 3: 73-81
- Prospective analysis of failure rate and predictors of failure after anatomic anterior cruciate ligament reconstruction with allograft.Am J Sports Med. 2012; 40: 800-807
- A study of time-dependent operating room fees and how to save $100 000 by using time-saving products.Am J Cosmet Surg. 2016; 22: 25-34
- What does one minute of operating room time cost?.J Clin Anesth. 2010; 22: 233-236
- Financial implications of obesity.Orthop Clin North Am. 2011; 42: 123-127, vii
- The obesity epidemic: Its effect on total joint arthroplasty.J Arthroplasty. 2007; 22: 71-76
- Arthroscopy and obesity.Orthop Traumatol Surg Res. 2015; 101: S351-S352
- Anterior cruciate ligament graft failure: A comparison of graft type based on age and Tegner activity level.Am J Sports Med. 2011; 39: 2194-2198
- Incidence of postoperative anterior cruciate ligament reconstruction infections: Graft choice makes a difference.Am J Sports Med. 2013; 41: 1780-1785
Article info
Publication history
Accepted:
July 20,
2018
Received:
September 25,
2017
Footnotes
The authors report the following potential conflict of interest or source of funding: S.C.G. receives support from Zimmer Biomet. G.F.R.H. receives support from Arthrex. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in this program are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
Identification
Copyright
© 2018 by the Arthroscopy Association of North America
