Operative Times Can Predict and Are Correlated With Lengths-of-Stay in Primary Total Knee Arthroplasty: A Nationwide Database Study

Sodhi, Nipun; Anis, Hiba K.; Gold, Peter A.; Garbarino, Luke J.; Scuderi, Giles R.; Cushner, Fred D.; Mont, Michael A.

doi:10.1016/j.arth.2019.03.024

Cited by 23 publications

(17 citation statements)

References 18 publications

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“…At the same time, prolonged use of tourniquets increases the risk of vascular and nerve damage. It has been proved that prolonged operation time increases the incidence of postoperative complications in patients with TKA ( 31 , 32 ). It has been reported in the literature that the risk of requiring blood transfusion and hospital readmission increased by 9% and 5% for each 15 min increase in the duration of TKA ( 33 ).…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram to predict complications in patients undergoing simultaneous bilateral total knee arthroplasty: A retrospective study from two centers

Zhang

Ren

et al. 2022

Front. Surg.

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PurposeComplications were significantly increased 30 days after Simultaneous bilateral total knee arthroplasty (SBTKA). In this study, an individualized nomogram was established and validated to predict the complications within 30 days after SBTKA.MethodsThe general data of 861 patients (training set) who received SBTKA in The Affiliated Hospital of Qingdao University between January 1, 2012 and March 31, 2017 were retrospectively analyzed. All patients were divided into complication group (n = 96) and non-complication group (n = 765) according to the incidence of complications within 30 years after SBTKA. Independent risk factors for postoperative SBTKA complications were identified and screened by binary logistic regression analyses, and then a nomogram prediction model was constructed using R software. The area under curve (AUC), calibration curve, and decision curve analysis (DCA) were selected to evaluate the line-chart. Meanwhile, 396 patients receiving SBTKA in the Third Hospital of Hebei Medical University who met the inclusion and exclusion criteria (test set) were selected to verify the nomogram.ResultsFive independent predictors were identified by binary logistic regression analyses and a nomogram was established. The AUC of this nomogram curve is 0.851 (95% CI: 0.819–0.883) and 0.818 (95% CI: 0.735–0.900) in the training and testing sets, respectively. In the training set and test set, calibration curves show that nomogram prediction results are in good agreement with actual observation results, and DCA shows that nomogram prediction results have good clinical application value.ConclusionOlder age, lower preoperative hemoglobin level, higher preoperative blood urea nitrogen (BUN) level, longer operation time, ASA grade ≥ III are independent predictors of SBTKA complications within 30 days after surgery. A nomogram containing these five predictors can accurately predict the risk of complications within 30 days after SBTKA.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram to predict complications in patients undergoing simultaneous bilateral total knee arthroplasty: A retrospective study from two centers

Zhang

Ren

et al. 2022

Front. Surg.

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“…In a report by Sodhi et al, 16 200,000 TKAs were analyzed with the majority of operative times found to be between 61 and 90 minutes long and that every 13-minute increase in operative time was associated with an increase in length of stay by 1 day. 16 Similarly, Peersman et al 17 were able to confirm that the duration of a TKA can be used as a risk predictor for surgical site infections. They reviewed 353 TKAs and found 113 patients with infections and 236 patients without infections.…”

Section: Discussionmentioning

confidence: 99%

Learning Curve of Robotic-Assisted Total Knee Arthroplasty for a High-Volume Surgeon

et al. 2020

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The learning curve has been established for robotic-assisted total knee arthroplasty (RATKA) during the first month of use; however, there have been no studies evaluating this on a longer term. Therefore, the purpose of this study was to compare operative times for three cohorts during the first year following adoption of RATKA (initial, 6 months, and 1 year) and a prior cohort of manual TKA. We investigated both mean operative times and the variability of operative time in each cohort. This is a learning curve study comparing a single surgeon's experience using RAKTA. The study groups were made up of two cohorts of 60 cementless RATKAs performed at ∼6 months and 1 year of use. A learning curve was created based on the mean operative times and individual operative times were stratified into different cohorts for comparison. Study groups were compared with the surgeon's initial group of 20 cemented RATKAs and 60 cementless manual cases. Descriptive numbers were compiled and mean operative times were compared using Student's t-tests for significant differences with a p-value of < 0.05. The mean surgical times continued to decrease after 6 months of RATKA. In 1 year, the surgeon was performing 88% of the RATKA between 50 and 69 minutes. The initial cohort and 1-year robotic-assisted mean operative times were 81 and 62 minutes, respectively (p < 0.00001). Mean 6-month robotic-assisted operative times were similar to manual times (p = 0.12). A significant lower time was found between the mean operative times for the 1-year robotic-assisted and manual (p = 0.008) TKAs. The data show continued improvement of operative times at 6 months and 1 year when using this new technology. The results of this study are important because they demonstrate how the complexity of a technology which initially increases operative time can be overcome and become more time-effective than conventional techniques.

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“…In addition, the operation time, primary diseases, and merge diseases might affect the LOS in patients. Sodhi et al reported that the operation time was closely related to LOS [23]. Sizer et al found that elder patients were easier to occur bleeding during operation and had increased complications [24].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with the length of stay in total knee arthroplasty patients with the enhanced recovery after surgery model

Weng

et al. 2019

J Orthop Surg Res

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Objectives: The purpose of this study is to identify the factors that influence the length of stay (LOS) in total knee arthroplasty (TKA) patients with an enhanced recovery after surgery (ERAS) program. Methods: Information from 167 patients (31 males and 136 females, range from 43 years to 88 years old) who underwent the unilateral elective primary TKA from January 2017 to January 2019 were reviewed retrospectively. Factors were analyzed by single-factor variance and multi-factor linear regression. Results: By single-factor variance analysis, American Society of Anesthesiologists (ASA) physical status classification system, pre-operation albumin, pre-operation erythrocyte sedimentation rate (ESR), primary and merge diseases, hidden blood loss, and length of operation were correlated with LOS (P < 0.05). Multi-factor linear regression results suggested that gender, ASA class, pre-operation Alb, and pre-operation ESR were associated with LOS (P < 0.05). Moreover, ASA class 3 (B value 4.84), pre-operation Alb < 30 g/L (B value 18.33), and pre-operation ESR > 15 mmol/h (B value 2.21) could increase the LOS, while males (B value − 3.56) had a shortened LOS. Conclusions: Overall, our research found that female, ASA class 3, pre-operation Alb < 30 g/L, and pre-operation ESR > 15 mmol/h could extend LOS in TKA patients with ERAS.

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Operative Times Can Predict and Are Correlated With Lengths-of-Stay in Primary Total Knee Arthroplasty: A Nationwide Database Study

Cited by 23 publications

References 18 publications

Development and validation of a nomogram to predict complications in patients undergoing simultaneous bilateral total knee arthroplasty: A retrospective study from two centers

Development and validation of a nomogram to predict complications in patients undergoing simultaneous bilateral total knee arthroplasty: A retrospective study from two centers

Learning Curve of Robotic-Assisted Total Knee Arthroplasty for a High-Volume Surgeon

Factors associated with the length of stay in total knee arthroplasty patients with the enhanced recovery after surgery model

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