Purpose
To determine whether operative time is an independent risk factor for 30-day complications
after arthroscopic surgical procedures on the knee.
Methods
The American College of Surgeons National Surgical Quality Improvement Program database
was queried between 2005 and 2016 for all arthroscopic knee procedures including lateral
release, loose body removal, synovectomy, chondroplasty, microfracture, and meniscectomy.
Cases with concomitant procedures were excluded. Correlations between operative time
and adverse events were controlled for variables such as age, sex, body mass index,
patient comorbidities, and procedure using a multivariate Poisson regression with
robust error variance.
Results
A total of 78,864 procedures met our inclusion and exclusion criteria. The mean age
of patients was 51.0 ± 14.3 years; mean operative time, 31.2 ± 18.1 minutes; and mean
body mass index, 31.0 ± 7.8. Arthroscopic lateral release (coefficient, 5.8; 95% confidence
interval [CI], 4.8-6.8; P < .001), removal of loose bodies (coefficient, 4.2; 95% CI, 3.2-5.3; P < .001), synovectomy (coefficient, 1.8; 95% CI, 1.2-2.3; P < .001), and microfracture (coefficient, 6.5; 95% CI, 5.8-7.2; P < .001) had significantly greater durations of surgery in comparison with meniscectomy.
The overall rate of adverse events was 1.24%. After we adjusted for demographic characteristics
and the procedure, a 15-minute increase in operative duration was associated with
an increased risk of transfusion (relative risk [RR], 1.5; 95% CI, 1.3-1.8; P < .001), death (RR, 1.6; 95% CI, 1.2-2.1; P = .005), dehiscence (RR, 1.6; 95% CI, 1.2-2.2; P = .002), surgical-site infection (RR, 1.3; 95% CI, 1.2-1.3; P = .001), sepsis (RR, 1.3; 95% CI, 1.2-1.4; P < .001), readmission (RR, 1.1; 95% CI, 1.1-1.2; P < .001), and extended length of stay (RR, 1.4; 95% CI, 1.3-1.4; P < .001).
Conclusions
Marginal increases in operative time are associated with an increased risk of adverse
events such as surgical-site infection, sepsis, extended length of stay, and readmission.
Efforts should be made to maximize surgical efficiency.
Level of Evidence
Level IV, retrospective database study.
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Article info
Publication history
Published online: June 18, 2019
Accepted:
January 29,
2019
Received:
June 3,
2018
Footnotes
See commentary on page 2099
The authors report the following potential conflicts of interest or sources of funding: B.F. receives research support from Arthrex and Smith and Nephew; receives publishing royalties and financial/material support from Elsevier; owns stock or stock options in Jace Medical; and is a paid consultant for and receives research support from Stryker. N.N.V. is a paid consultant for and receives research support from Arthrex; receives publishing royalties from Arthroscopy; receives research support from Arthrosurface, DJ Orthopaedics, Össur, Smith & Nephew, Athletico, ConMed Linvatec, Miomed, and Mitek; owns stock or stock options in Cymedica and Omeros; is a paid consultant for and owns stock or stock options in Minivasive; is a paid consultant for Orthospace; receives IP royalties from Smith & Nephew; and receives publishing royalties and financial/material support from Vindico Medical-Orthopedics Hyperguide. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2019 by the Arthroscopy Association of North America
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Access this article on ScienceDirectLinked Article
- Editorial Commentary: Knee Arthroscopy: How Fast Is Too Fast? How Slow Is Too Slow?ArthroscopyVol. 35Issue 7
- PreviewAlthough the quality of knee arthroscopy is not determined with a stopwatch, in general, an operation should not take significantly longer than average for a routine and uncomplicated procedure. On the other hand, rushing through an operation is never acceptable. Hurrying to complete an operation to meet a given time standard is not only undesirable, but also unsafe for the patient.
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