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

Agarwalla, Avinesh; Gowd, Anirudh K.; Liu, Joseph N.; Garcia, Grant H.; Bohl, Daniel D.; Verma, Nikhil N.; Forsythe, Brian

doi:10.1177/2325967118825453

Cited by 45 publications

(44 citation statements)

References 56 publications

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“…The association between a longer operating time and a higher risk of infection has been established in operative procedures in general. 11 Agarwalla and colleagues 1 used data from the American College of Surgeons National Surgical Quality Improvement Program database to show that an increase in operating time in ACLR increased the risk of surgical site infection. A study of the same database, but focusing on knee arthroscopic procedures excluding ACLR, found a linear relationship between an increase in operating time and an increase in surgical site infection and sepsis.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Septic Arthritis After Anterior Cruciate Ligament Reconstruction: A Nationwide Analysis of 26,014 ACL Reconstructions

et al. 2021

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Background: Septic arthritis (SA) after anterior cruciate ligament reconstruction (ACLR) is a rare yet severe complication. The samples in previous studies have been small and without nationwide coverage, making analysis uncertain with a risk of bias. Conclusions to recommend preventive measures are therefore difficult to draw, and it has not been possible to perform a comprehensive risk factor analysis. Purpose: To study the incidence of SA after ACLR in a large, nationwide population and to study the risk factors for SA after ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: All ACLRs, primary and revision, in the Swedish Knee Ligament Registry between 2006 and 2013 were linked with data from the Swedish National Board of Health and Welfare. The incidence of SA events was determined using entries from the day of surgery until 90 days postoperatively based on diagnosis codes and the prescription of antibiotics. All events of SA were verified via a review of medical records. Risk factors were analyzed based on data from the registries. Descriptive statistics were used to describe the findings, while logistic regression analysis was used for the risk analysis. Results: The cohort consisted of 26,014 primary and revision ACLRs. During the study period, 298 events of SA (1.1%) were identified. The high-volume units (≥500 ACLRs during the study period) had a distribution of SA between 2 and 47 (0.2%-2.9%). Independent risk factors of SA were male sex (OR, 1.65; 95% CI, 1.28-2.13), operating time ≥70 minutes (OR, 1.83; 95% CI, 1.42-2.36), hamstring tendon autograft (OR, 2.23; 95% CI, 1.21-4.08), and clindamycin as perioperative antibiotic prophylaxis (OR, 1.94; 95% CI, 1.10-3.41). Conclusion: The incidence of SA after ACLR in this nationwide cohort was 1.1%. Male sex, hamstring tendon autografts, and a longer operating time were all independent risk factors for SA. The use of clindamycin as perioperative antibiotic prophylaxis was a risk factor compared with the use of cloxacillin. Some high-volume units had a very low infection rate (0.2%).

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Septic Arthritis After Anterior Cruciate Ligament Reconstruction: A Nationwide Analysis of 26,014 ACL Reconstructions

et al. 2021

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“…A linear relationship between operative time and the risk of adverse events after total joint arthroplasty, anterior cruciate ligament reconstruction, anterior cervical diskectomy, and ankle open reduction internal fixation has previously been established. 1,8,17,31 Therefore, identifying incremental increases in operative time as an independent risk factor for complications after arthroscopic rotator cuff repair would emphasize the need for operative efficiency and the significance for surgical planning in this patient population.…”

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confidence: 99%

A 15-Minute Incremental Increase in Operative Duration Is Associated With an Additional Risk of Complications Within 30 Days After Arthroscopic Rotator Cuff Repair

Agarwalla

Gowd

Yao

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Operative time is a risk factor for short-term complications after orthopaedic procedures; however, it has yet to be investigated as an independent risk factor for postoperative complications after arthroscopic rotator cuff repair. Purpose: To determine whether operative time is an independent risk factor for complications, readmissions, and extended hospital stays within 30 days after arthroscopic rotator cuff repair. Study Design: Descriptive epidemiology study. Methods: The American College of Surgeons National Surgical Quality Improvement Program was queried for all hospital-based inpatient and outpatient arthroscopic rotator cuff repairs (Current Procedural Terminology code 29827) from 2005 to 2016. Concomitant procedures such as subacromial decompression, biceps tenodesis, superior labrum anterior and posterior (SLAP) repair, labral repair, and distal clavicle excision were also included, whereas patients undergoing arthroplasty were excluded from the study. Operative time was correlated with patient demographics, comorbidities, and concomitant procedures. All adverse events were correlated with operative time, while controlling for the above preoperative variables, using multivariate Poisson regression with a robust error variance. Results: A total of 27,524 procedures met inclusion and exclusion criteria. The mean age of patients was 58.4 ± 10.9 years, the mean operative time was 86.9 ± 37.4 minutes, and the mean body mass index was 30.4 ± 7.0 kg/m2. Concomitant biceps tenodesis, glenohumeral debridement, SLAP repair, labral repair, and distal clavicle excision significantly increased operative time ( P < .001) but not the risk of adverse events ( P > .05). The overall rate of adverse events was 0.88%. After adjusting for demographic and procedural characteristics, a 15-minute increase in operative duration was associated with an increased risk of anemia requiring transfusion (relative risk [RR], 1.27 [95% CI, 1.14-1.42]; P < .001), venous thromboembolism (RR, 1.17 [95% CI, 1.02-1.35]; P = .029), surgical site infection (RR, 1.13 [95% CI, 1.03-1.24]; P = .011), and extended length of hospital stay (RR, 1.07 [95% CI, 1.00-1.14]; P = .036). Conclusion: Although the rate of short-term complications after arthroscopic rotator cuff repair is low, incremental increases in operative time are associated with an increased risk of adverse events such as surgical site infection, pulmonary embolism, transfusion, and extended length of hospital stay. Efforts should be made to maximize surgical efficiency in the operating room through optimal coordination of the staff or increased preoperative planning.

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“…A recent study evaluating the effect of the duration of ACLR procedures on complications reported that a 15-minute increase in operative time was associated with a higher risk of surgical site infections (relative risk, 1.21; 95% CI: 1.08-1.35; p ¼ 0.001). 7 Therefore, our observed increase in operative duration of resident-assisted ACLR may be insufficient to significantly affect postoperative infection rates.…”

Section: Discussionmentioning

confidence: 83%

“…recently become the subject of close scrutiny due to the reported increase in complication rates association with longer operative times observed in resident-assisted cases. 6,7 Previous studies have used the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to assess the impact of resident participation in various orthopaedic procedures on postoperative outcomes, with conflicting results. One analysis of 30,628 orthopaedic surgery cases demonstrated that resident involvement was associated with decreased complications.…”

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confidence: 99%

The Impact of Resident Involvement on Surgical Outcomes following Anterior Cruciate Ligament Reconstruction

et al. 2019

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Hands-on participation in the operating room (OR) is an integral component of surgical resident training. However, the implications of resident involvement in many orthopaedic procedures are not well defined. This study aims to assess the effect of resident involvement on short-term outcomes following anterior cruciate ligament reconstruction (ACLR). The National Surgical Quality Improvement Program (NSQIP) database was queried to identify all patients who underwent ACLR from 2005 to 2012. Demographic variables, resident participation, 30-day complications, and intraoperative time parameters were assessed for all cases. Resident and nonresident cases were matched using propensity scores. Outcomes were analyzed using univariate and multivariate regression analyses, as well as stratified by resident level of training. Univariate analysis of 1,222 resident and 1,188 nonresident cases demonstrated no difference in acute postoperative complication rates between groups. There was no significant difference in the incidence of overall complications based on resident level of training (p = 0.109). Operative time was significantly longer for cases in which a resident was involved (109.5 vs. 101.7 minutes; p < 0.001). Multivariate analysis identified no significant predictors of major postoperative complications, while patient history of chronic obstructive pulmonary disease was the only independent risk factor associated with minor complications. Resident involvement in ACLR was not associated with 30-day complications despite a slight increase in operative time. These findings provide reassurance that resident involvement in ACLR procedures is safe, although future investigations should focus on long-term postoperative outcomes.

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

Cited by 45 publications

References 56 publications

Risk Factors for Septic Arthritis After Anterior Cruciate Ligament Reconstruction: A Nationwide Analysis of 26,014 ACL Reconstructions

Risk Factors for Septic Arthritis After Anterior Cruciate Ligament Reconstruction: A Nationwide Analysis of 26,014 ACL Reconstructions

A 15-Minute Incremental Increase in Operative Duration Is Associated With an Additional Risk of Complications Within 30 Days After Arthroscopic Rotator Cuff Repair

The Impact of Resident Involvement on Surgical Outcomes following Anterior Cruciate Ligament Reconstruction

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