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Procedure length is independently associated with overnight hospital stay and 30-day readmission following anterior cruciate ligament reconstruction
Purpose The purpose was to characterize the independent effect of procedure length on the rates of 30-day perioperative complications, hospital readmissions, and overnight hospital stay in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). We hypothesized that longer...
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| Published in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2020-02, Vol.28 (2), p.432-438 |
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| container_end_page | 438 |
| container_issue | 2 |
| container_start_page | 432 |
| container_title | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
| container_volume | 28 |
| creator | Boddapati, Venkat Fu, Michael C. Nwachukwu, Benedict U. Camp, Christopher L. Spiker, Andrea M. Williams, Riley J. Ranawat, Anil S. |
| description | Purpose
The purpose was to characterize the independent effect of procedure length on the rates of 30-day perioperative complications, hospital readmissions, and overnight hospital stay in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). We hypothesized that longer procedure length in primary ACLR increases the risk for post-operative complications.
Methods
Primary ACLR cases from 2005 to 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program registry. Patients were categorized into two cohorts based on procedure length, either less than or greater than 90 min. Two equal-sized propensity-matched cohorts were generated to account for differences in baseline and operative characteristics. Thirty-day clinical outcomes were compared using bivariate analyses between propensity-matched groups that controlled for patient-specific factors and concurrent meniscal repair. Multivariate logistic regression models were used to identify independent predictors of hospital readmission and overnight hospital stay.
Results
In total, 12,077 ACLR cases were identified. The rate of any 30-day complication was increased in longer procedures relative to shorter procedures (1.6% vs 0.9%,
p
= 0.006), as were the rates of returning to the operating room (0.6% vs 0.3%,
p
= 0.03), hospital readmission (1.0% vs 0.3%,
p
= 0.001), and overnight hospital stay (16.2% vs 6.0%,
p
|
| doi_str_mv | 10.1007/s00167-019-05622-z |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2263321826</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2263321826</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-e626f31de0095e3ac2a9adab65b2e053159e776329debbc689a55dc59e0d06073</originalsourceid><addsrcrecordid>eNp9kctuFDEQRS0EIsPAD7BAltiwMfjRbk8vUcRLikQWydpy2zU9jnrswXYTJd_BB1PJBJBYZOOyqs69VdIl5LXg7wXn5kPlXPSGcTEwrnsp2e0TshKdUsyozjwlKz50kkmcnZAXtV5xjt9ueE5OlFBqo6VZkV_nJXsISwE6Q5rajsZKYwpwAHxSm2-oqzX76BoEeh0RyD-hpDjtGt3leojNzbQ2h1wKVHEW8FvAhX2sNeZEt3me83VMEwINSsyF-rLcG9I5Tm6PW1Dgc6oN-w01L8mzrZsrvHqoa3L5-dPF6Vd29v3Lt9OPZ8wroxuDXvZbJQJwPmhQzks3uODGXo8SuFZCD2BMr-QQYBx9vxmc1sFjlwfec6PW5N3R91DyjwVqs3i0h3l2CfJSrZS9UlJssKzJ2__Qq7yUhNfdUVJ3RuHGNZFHypdca4GtPZS4d-XGCm7vMrPHzCxmZu8zs7coevNgvYx7CH8lf0JCQB2BiqM0Qfm3-xHb37QEpik</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2262547305</pqid></control><display><type>article</type><title>Procedure length is independently associated with overnight hospital stay and 30-day readmission following anterior cruciate ligament reconstruction</title><source>EBSCOhost SPORTDiscus with Full Text</source><source>Springer Nature</source><source>Wiley-Blackwell Read & Publish Collection</source><creator>Boddapati, Venkat ; Fu, Michael C. ; Nwachukwu, Benedict U. ; Camp, Christopher L. ; Spiker, Andrea M. ; Williams, Riley J. ; Ranawat, Anil S.</creator><creatorcontrib>Boddapati, Venkat ; Fu, Michael C. ; Nwachukwu, Benedict U. ; Camp, Christopher L. ; Spiker, Andrea M. ; Williams, Riley J. ; Ranawat, Anil S.</creatorcontrib><description>Purpose
The purpose was to characterize the independent effect of procedure length on the rates of 30-day perioperative complications, hospital readmissions, and overnight hospital stay in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). We hypothesized that longer procedure length in primary ACLR increases the risk for post-operative complications.
Methods
Primary ACLR cases from 2005 to 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program registry. Patients were categorized into two cohorts based on procedure length, either less than or greater than 90 min. Two equal-sized propensity-matched cohorts were generated to account for differences in baseline and operative characteristics. Thirty-day clinical outcomes were compared using bivariate analyses between propensity-matched groups that controlled for patient-specific factors and concurrent meniscal repair. Multivariate logistic regression models were used to identify independent predictors of hospital readmission and overnight hospital stay.
Results
In total, 12,077 ACLR cases were identified. The rate of any 30-day complication was increased in longer procedures relative to shorter procedures (1.6% vs 0.9%,
p
= 0.006), as were the rates of returning to the operating room (0.6% vs 0.3%,
p
= 0.03), hospital readmission (1.0% vs 0.3%,
p
= 0.001), and overnight hospital stay (16.2% vs 6.0%,
p
< 0.001). Obesity was a risk factor for both hospital readmission and overnight hospital stay, while hypertension, diabetes, chronic obstructive pulmonary disease, and a smoking history were associated with increased rates of overnight hospital stay. The most common reasons for hospital readmission were deep vein thrombosis or pulmonary embolism (25.0% of all readmitted patients), surgical site infection (25.0%), and post-operative pain (14.1%).
Conclusions
In this propensity-matched analysis adjusting for baseline patient characteristics and operative factors, procedure length of greater than or equal to 90 min in ACLR was independently associated with an increased risk of hospital readmission and overnight hospital stay. As a surrogate measure of surgical complexity, operative time may be a useful perioperative variable for post-operative risk stratification and patient counseling.
Level of evidence
III</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-019-05622-z</identifier><identifier>PMID: 31338527</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Anterior cruciate ligament ; Bivariate analysis ; Chronic obstructive pulmonary disease ; Complications ; Diabetes mellitus ; Embolism ; Hospitals ; Hypertension ; Knee ; Lung diseases ; Medical personnel ; Medicine ; Medicine & Public Health ; Meniscus ; Obstructive lung disease ; Orthopedics ; Pain ; Patient admissions ; Patients ; Quality control ; Regression analysis ; Regression models ; Risk analysis ; Risk factors ; Smoking ; Surgical site infections ; Thromboembolism ; Thrombosis</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2020-02, Vol.28 (2), p.432-438</ispartof><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019</rights><rights>Knee Surgery, Sports Traumatology, Arthroscopy is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-e626f31de0095e3ac2a9adab65b2e053159e776329debbc689a55dc59e0d06073</citedby><cites>FETCH-LOGICAL-c375t-e626f31de0095e3ac2a9adab65b2e053159e776329debbc689a55dc59e0d06073</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31338527$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Boddapati, Venkat</creatorcontrib><creatorcontrib>Fu, Michael C.</creatorcontrib><creatorcontrib>Nwachukwu, Benedict U.</creatorcontrib><creatorcontrib>Camp, Christopher L.</creatorcontrib><creatorcontrib>Spiker, Andrea M.</creatorcontrib><creatorcontrib>Williams, Riley J.</creatorcontrib><creatorcontrib>Ranawat, Anil S.</creatorcontrib><title>Procedure length is independently associated with overnight hospital stay and 30-day readmission following anterior cruciate ligament reconstruction</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
The purpose was to characterize the independent effect of procedure length on the rates of 30-day perioperative complications, hospital readmissions, and overnight hospital stay in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). We hypothesized that longer procedure length in primary ACLR increases the risk for post-operative complications.
Methods
Primary ACLR cases from 2005 to 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program registry. Patients were categorized into two cohorts based on procedure length, either less than or greater than 90 min. Two equal-sized propensity-matched cohorts were generated to account for differences in baseline and operative characteristics. Thirty-day clinical outcomes were compared using bivariate analyses between propensity-matched groups that controlled for patient-specific factors and concurrent meniscal repair. Multivariate logistic regression models were used to identify independent predictors of hospital readmission and overnight hospital stay.
Results
In total, 12,077 ACLR cases were identified. The rate of any 30-day complication was increased in longer procedures relative to shorter procedures (1.6% vs 0.9%,
p
= 0.006), as were the rates of returning to the operating room (0.6% vs 0.3%,
p
= 0.03), hospital readmission (1.0% vs 0.3%,
p
= 0.001), and overnight hospital stay (16.2% vs 6.0%,
p
< 0.001). Obesity was a risk factor for both hospital readmission and overnight hospital stay, while hypertension, diabetes, chronic obstructive pulmonary disease, and a smoking history were associated with increased rates of overnight hospital stay. The most common reasons for hospital readmission were deep vein thrombosis or pulmonary embolism (25.0% of all readmitted patients), surgical site infection (25.0%), and post-operative pain (14.1%).
Conclusions
In this propensity-matched analysis adjusting for baseline patient characteristics and operative factors, procedure length of greater than or equal to 90 min in ACLR was independently associated with an increased risk of hospital readmission and overnight hospital stay. As a surrogate measure of surgical complexity, operative time may be a useful perioperative variable for post-operative risk stratification and patient counseling.
Level of evidence
III</description><subject>Anterior cruciate ligament</subject><subject>Bivariate analysis</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Complications</subject><subject>Diabetes mellitus</subject><subject>Embolism</subject><subject>Hospitals</subject><subject>Hypertension</subject><subject>Knee</subject><subject>Lung diseases</subject><subject>Medical personnel</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meniscus</subject><subject>Obstructive lung disease</subject><subject>Orthopedics</subject><subject>Pain</subject><subject>Patient admissions</subject><subject>Patients</subject><subject>Quality control</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Smoking</subject><subject>Surgical site infections</subject><subject>Thromboembolism</subject><subject>Thrombosis</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kctuFDEQRS0EIsPAD7BAltiwMfjRbk8vUcRLikQWydpy2zU9jnrswXYTJd_BB1PJBJBYZOOyqs69VdIl5LXg7wXn5kPlXPSGcTEwrnsp2e0TshKdUsyozjwlKz50kkmcnZAXtV5xjt9ueE5OlFBqo6VZkV_nJXsISwE6Q5rajsZKYwpwAHxSm2-oqzX76BoEeh0RyD-hpDjtGt3leojNzbQ2h1wKVHEW8FvAhX2sNeZEt3me83VMEwINSsyF-rLcG9I5Tm6PW1Dgc6oN-w01L8mzrZsrvHqoa3L5-dPF6Vd29v3Lt9OPZ8wroxuDXvZbJQJwPmhQzks3uODGXo8SuFZCD2BMr-QQYBx9vxmc1sFjlwfec6PW5N3R91DyjwVqs3i0h3l2CfJSrZS9UlJssKzJ2__Qq7yUhNfdUVJ3RuHGNZFHypdca4GtPZS4d-XGCm7vMrPHzCxmZu8zs7coevNgvYx7CH8lf0JCQB2BiqM0Qfm3-xHb37QEpik</recordid><startdate>20200201</startdate><enddate>20200201</enddate><creator>Boddapati, Venkat</creator><creator>Fu, Michael C.</creator><creator>Nwachukwu, Benedict U.</creator><creator>Camp, Christopher L.</creator><creator>Spiker, Andrea M.</creator><creator>Williams, Riley J.</creator><creator>Ranawat, Anil S.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20200201</creationdate><title>Procedure length is independently associated with overnight hospital stay and 30-day readmission following anterior cruciate ligament reconstruction</title><author>Boddapati, Venkat ; Fu, Michael C. ; Nwachukwu, Benedict U. ; Camp, Christopher L. ; Spiker, Andrea M. ; Williams, Riley J. ; Ranawat, Anil S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-e626f31de0095e3ac2a9adab65b2e053159e776329debbc689a55dc59e0d06073</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anterior cruciate ligament</topic><topic>Bivariate analysis</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Complications</topic><topic>Diabetes mellitus</topic><topic>Embolism</topic><topic>Hospitals</topic><topic>Hypertension</topic><topic>Knee</topic><topic>Lung diseases</topic><topic>Medical personnel</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meniscus</topic><topic>Obstructive lung disease</topic><topic>Orthopedics</topic><topic>Pain</topic><topic>Patient admissions</topic><topic>Patients</topic><topic>Quality control</topic><topic>Regression analysis</topic><topic>Regression models</topic><topic>Risk analysis</topic><topic>Risk factors</topic><topic>Smoking</topic><topic>Surgical site infections</topic><topic>Thromboembolism</topic><topic>Thrombosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Boddapati, Venkat</creatorcontrib><creatorcontrib>Fu, Michael C.</creatorcontrib><creatorcontrib>Nwachukwu, Benedict U.</creatorcontrib><creatorcontrib>Camp, Christopher L.</creatorcontrib><creatorcontrib>Spiker, Andrea M.</creatorcontrib><creatorcontrib>Williams, Riley J.</creatorcontrib><creatorcontrib>Ranawat, Anil S.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>ProQuest Nursing and Allied Health Source</collection><collection>Physical Education Index</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Boddapati, Venkat</au><au>Fu, Michael C.</au><au>Nwachukwu, Benedict U.</au><au>Camp, Christopher L.</au><au>Spiker, Andrea M.</au><au>Williams, Riley J.</au><au>Ranawat, Anil S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Procedure length is independently associated with overnight hospital stay and 30-day readmission following anterior cruciate ligament reconstruction</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2020-02-01</date><risdate>2020</risdate><volume>28</volume><issue>2</issue><spage>432</spage><epage>438</epage><pages>432-438</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
The purpose was to characterize the independent effect of procedure length on the rates of 30-day perioperative complications, hospital readmissions, and overnight hospital stay in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). We hypothesized that longer procedure length in primary ACLR increases the risk for post-operative complications.
Methods
Primary ACLR cases from 2005 to 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program registry. Patients were categorized into two cohorts based on procedure length, either less than or greater than 90 min. Two equal-sized propensity-matched cohorts were generated to account for differences in baseline and operative characteristics. Thirty-day clinical outcomes were compared using bivariate analyses between propensity-matched groups that controlled for patient-specific factors and concurrent meniscal repair. Multivariate logistic regression models were used to identify independent predictors of hospital readmission and overnight hospital stay.
Results
In total, 12,077 ACLR cases were identified. The rate of any 30-day complication was increased in longer procedures relative to shorter procedures (1.6% vs 0.9%,
p
= 0.006), as were the rates of returning to the operating room (0.6% vs 0.3%,
p
= 0.03), hospital readmission (1.0% vs 0.3%,
p
= 0.001), and overnight hospital stay (16.2% vs 6.0%,
p
< 0.001). Obesity was a risk factor for both hospital readmission and overnight hospital stay, while hypertension, diabetes, chronic obstructive pulmonary disease, and a smoking history were associated with increased rates of overnight hospital stay. The most common reasons for hospital readmission were deep vein thrombosis or pulmonary embolism (25.0% of all readmitted patients), surgical site infection (25.0%), and post-operative pain (14.1%).
Conclusions
In this propensity-matched analysis adjusting for baseline patient characteristics and operative factors, procedure length of greater than or equal to 90 min in ACLR was independently associated with an increased risk of hospital readmission and overnight hospital stay. As a surrogate measure of surgical complexity, operative time may be a useful perioperative variable for post-operative risk stratification and patient counseling.
Level of evidence
III</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>31338527</pmid><doi>10.1007/s00167-019-05622-z</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0942-2056 |
| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2020-02, Vol.28 (2), p.432-438 |
| issn | 0942-2056 1433-7347 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2263321826 |
| source | EBSCOhost SPORTDiscus with Full Text; Springer Nature; Wiley-Blackwell Read & Publish Collection |
| subjects | Anterior cruciate ligament Bivariate analysis Chronic obstructive pulmonary disease Complications Diabetes mellitus Embolism Hospitals Hypertension Knee Lung diseases Medical personnel Medicine Medicine & Public Health Meniscus Obstructive lung disease Orthopedics Pain Patient admissions Patients Quality control Regression analysis Regression models Risk analysis Risk factors Smoking Surgical site infections Thromboembolism Thrombosis |
| title | Procedure length is independently associated with overnight hospital stay and 30-day readmission following anterior cruciate ligament reconstruction |
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