Increased hip arthroscopy operative duration is an independent risk factor for overnight hospital admission

Abstract

PurposeThe purpose of this study was to determine the association between operative duration and short‐term complications as well as overnight hospital admission following hip arthroscopy. MethodsHip arthroscopy cases from 2006 to 2016 were retrieved from the National Surgical Quality Improvement Program registry, which prospectively collects 30‐day postoperative complications. Patients were stratified into the following groups based on procedure length: group 1 (< 60 min), group 2 (60–120 min), and group 3 (> 120 min). Preoperative characteristics were compared across the cohorts. Multivariate regressions were used to compare complication rates and overnight hospital admission between the three groups. Independent risk factors for overnight hospital admission were characterized. ResultsA total of 2129 hip arthroscopy cases were identified. Average operative duration was 99.3 ± 55.7 min. As operative time increased, patients were more likely to be younger, male, and had lower American Society of Anesthesiologists (ASA) class (p < 0.001). Body mass index and comorbidity profiles were similar across the patient cohorts, with the exception of hypertension being more prevalent in the shorter operative time cohort (p < 0.001). Patients in group 3 were more likely to stay overnight in the hospital (26.0%) compared to patients in groups 1 (7.7%) and 2 (10.9%), p < 0.001). All postoperative complication rates were otherwise similar between the cohorts. Independent risk factors for overnight hospital admission included increasing operative time (most notably > 120 min relative to < 60 min, relative risk [RR] = 3.53, 95% CI 2.50–5.00, p < 0.001) and increasing ASA classification (most notably ASA III or IV relative to ASA I, RR = 1.64, 95% CI 1.18–2.27; p = 0.013). ConclusionsIncreasing operative duration was not associated with increased postoperative complications following hip arthroscopy. However, patients were more than three times likely to stay in the hospital overnight if their surgery was longer than 120 min, relative to cases that were less than 60 min. Level of evidenceIII.

Machine Learning Model Identifies Increased Operative Time and Greater BMI as Predictors for Overnight Admission After Outpatient Hip Arthroscopy

“…8 On the other hand, Bovonratwet et al focused specifically on overnight admission after hip arthroscopy and concluded that operative time of 60-120 min was an independent risk factor for overnight hospital admission. 9 The authors reported an overall readmission rate of 14%, which is comparable to the 9% overnight admission rate from the present study. The findings of our study concur with Bovonratwet et al: Increased operative time was a strong positive predictor of overnight hospital admission after outpatient hip arthroscopy.…”

“…Several investigations have used conventional statistical modeling to determine risk factors for inpatient admission after hip arthroscopy. 8,9,21,22 Du et al identified 1,931 patients who underwent hip arthroscopy and the rate of 30-day readmission following index procedure was estimated to be 0.9%. 8 Multivariate analysis identified increasing BMI, chronic corticosteroid use, and perioperative blood transfusions as independent risk factors associated with unplanned admission within 30 days after surgery.…”

“…22 Two other investigations also using the NSQIP database demonstrated conflicting results regarding the role of operative time. 8,9 Du et al found that increased operative time was not significantly associated with 30-day unplanned admission. 8 On the other hand, Bovonratwet et al focused specifically on overnight admission after hip arthroscopy and concluded that operative time of 60-120 min was an independent risk factor for overnight hospital admission.…”

“…Several investigations have used conventional statistical modeling to determine risk factors for inpatient admission after hip arthroscopy. 8 , 9 , 21 , 22 Du et al. identified 1,931 patients who underwent hip arthroscopy and the rate of 30-day readmission following index procedure was estimated to be 0.9%.…”

“… 7 While hip arthroscopy is generally viewed as a safe procedure in the outpatient setting, studies have identified risk factors for perioperative and postoperative adverse events, including greater body mass index (BMI), increased surgical duration, and chronic corticosteroid use . 8 , 9 Overnight admission following elective outpatient hip arthroscopy has implications on both clinical outcomes as well as cost, particularly due to fees from inpatient services. Identifying patients that may require inpatient admission after hip arthroscopy allows surgeons to counsel patients regarding their postoperative course, and perhaps work on future strategies to mitigate overnight admission.…”