Skip to main content
SpringerLink
Log in

Procedure length is independently associated with overnight hospital stay and 30-day readmission following anterior cruciate ligament reconstruction

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. ACS NSQIP Participant Use Data Files. https://www.facs.org/quality-programs/acs-nsqip/program-specifics/participant-use. Accessed May 1, 2017

  2. Adala R, Anand A, Kodikal G (2011) Deep vein thrombosis and thromboprophylaxis in arthroscopic anterior cruciate ligament reconstruction. Indian J Orthop 45:450–453

    Article  Google Scholar 

  3. Ardern CL, Taylor NF, Feller JA, Webster KE (2014) Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 48:1543–1552

    Article  Google Scholar 

  4. Blokhin IO, Lentz SR (2015) Mechanisms of thrombosis in obesity. Curr Opin Hematol 20:437–444

    Article  Google Scholar 

  5. Boddapati V, Fu MC, Mayman DJ, Su EP, Sculco PK, McLawhorn AS (2018) Revision total knee arthroplasty for periprosthetic joint infection is associated with increased postoperative morbidity and mortality relative to noninfectious revisions. J Arthroplasty 33:521–526

    Article  Google Scholar 

  6. Boddapati V, Fu MC, Schairer WW, Ranawat AS, Dines DM, Dines JS (2017) Increased shoulder arthroscopy time is associated with overnight hospital stay and surgical site infection. Arthroscopy 34:363–368

    Article  Google Scholar 

  7. Brophy RH, Huston LJ, Wright RW, Nwosu SK, Kaeding CC, Parker RD et al (2016) Outcomes of ACL reconstruction in patients with diabetes. Med Sci Sports Exerc 48:969–973

    Article  CAS  Google Scholar 

  8. Cancienne JM, Gwathmey FW, Werner BC (2016) Intraoperative corticosteroid injection at the time of knee arthroscopy is associated with increased postoperative infection rates in a large medicare population. Arthroscopy 32:90–95

    Article  Google Scholar 

  9. Cancienne JM, Mahon HS, Dempsey IJ, Miller MD, Werner BC (2017) Patient-related risk factors for infection following knee arthroscopy: an analysis of over 700,000 patients from two large databases. Knee 24:594–600

    Article  Google Scholar 

  10. Capito NM, Smith MJ, Stoker AM, Werner N, Cook JL (2015) Hyperosmolar irrigation compared with a standard solution in a canine shoulder arthroscopy model. J Shoulder Elbow Surg 24:1243–1248

    Article  Google Scholar 

  11. Cvetanovich GL, Chalmers PN, Verma NN, Cole BJ, Bach BR Jr (2016) Risk factors for short-term complications of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 44:618–624

    Article  Google Scholar 

  12. Davenport DL, Holsapple CW, Conigliaro J (2009) Assessing surgical quality using administrative and clinical data sets: a direct comparison of the university health system consortium clinical database and the national surgical quality improvement program data set. Am J Med Qual 24:395–402

    Article  Google Scholar 

  13. Fu MC, Boddapati V, Gausden EB, Samuel AM, Russell LA, Lane JM (2017) Surgery for a fracture of the hip within 24 hours of admission is independently associated with reduced short-term post-operative complications. Bone Joint J 99b:1216–1222

    Article  Google Scholar 

  14. Garrett WE Jr, Swiontkowski MF, Weinstein JN, Callaghan J, Rosier RN, Berry DJ et al (2006) American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. J Bone Joint Surg Am 88:660–667

    Article  Google Scholar 

  15. Gaskill T, Pullen M, Bryant B, Sicignano N, Evans AM, DeMaio M (2015) The prevalence of symptomatic deep venous thrombosis and pulmonary embolism after anterior cruciate ligament reconstruction. Am J Sports Med 43:2714–2719

    Article  Google Scholar 

  16. Hetsroni I, Lyman S, Do H, Mann G, Marx RG (2011) Symptomatic pulmonary embolism after outpatient arthroscopic procedures of the knee: the incidence and risk factors in 418,323 arthroscopies. J Bone Joint Surg Br 93:47–51

    Article  CAS  Google Scholar 

  17. Indelli PF, Dillingham M, Fanton G, Schurman DJ (2002) Septic arthritis in postoperative anterior cruciate ligament reconstruction. Clin Orthop Relat Res 398:182–188

    Article  Google Scholar 

  18. Kaye ID, Patel DN, Strauss EJ, Alaia MJ, Garofolo G, Martinez A et al (2015) Prevention of venous thromboembolism after arthroscopic knee surgery in a low-risk population with the use of aspirin a randomized trial. Bull Hosp Jt Dis 73:243–248

    Google Scholar 

  19. Lawson EH, Louie R, Zingmond DS, Brook RH, Hall BL, Han L et al (2012) A comparison of clinical registry versus administrative claims data for reporting of 30-day surgical complications. Ann Surg 256:973–981

    Article  Google Scholar 

  20. Le BT, Wu XL, Lam PH, Murrell GA (2014) Factors predicting rotator cuff retears: an analysis of 1000 consecutive rotator cuff repairs. Am J Sports Med 42:1134–1142

    Article  Google Scholar 

  21. Lunt M (2014) Selecting an appropriate caliper can be essential for achieving good balance with propensity score matching. Am J Epidemiol 179:226–235

    Article  Google Scholar 

  22. Lyman S, Koulouvaris P, Sherman S, Do H, Mandl LA, Marx RG (2009) Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am 91:2321–2328

    Article  Google Scholar 

  23. McAllister DR, Parker RD, Cooper AE, Recht MP, Abate J (1999) Outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction. Am J Sports Med 27:562–570

    Article  CAS  Google Scholar 

  24. Nwachukwu BU, Voleti PB, Berkanish P, Chang B, Cohn MR, Williams RJ 3rd et al (2017) Return to play and patient satisfaction after acl reconstruction: study with minimum 2-year follow-up. J Bone Joint Surg Am 99:720–725

    Article  Google Scholar 

  25. Pan X, Ye L, Liu Z, Wen H, Hu Y, Xu X (2015) Effect of irrigation fluid temperature on core body temperature and inflammatory response during arthroscopic shoulder surgery. Arch Orthop Trauma Surg 135:1131–1139

    Article  Google Scholar 

  26. Parodi D, Valderrama J, Tobar C, Besomi J, Lopez J, Lara J et al (2014) Effect of warmed irrigation solution on core body temperature during hip arthroscopy for femoroacetabular impingement. Arthroscopy 30:36–41

    Article  Google Scholar 

  27. Scillia AJ, Issa K, Boylan MR, McDermott JD, McInerney VK, Patel DV et al (2016) Inpatient cruciate ligament reconstruction in the United States: a nationwide database study from 1998 to 2010. Orthopedics 39:e196–202

    Article  Google Scholar 

  28. Shields E, Thirukumaran C, Thorsness R, Noyes K, Voloshin I (2015) An analysis of adult patient risk factors and complications within 30 days after arthroscopic shoulder surgery. Arthroscopy 31:807–815

    Article  Google Scholar 

  29. Shiloach M, Frencher SK Jr, Steeger JE, Rowell KS, Bartzokis K, Tomeh MG et al (2010) Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 210:6–16

    Article  Google Scholar 

  30. Struijk-Mulder MC, Ettema HB, Verheyen CC, Buller HR (2013) Deep vein thrombosis after arthroscopic anterior cruciate ligament reconstruction: a prospective cohort study of 100 patients. Arthroscopy 29:1211–1216

    Article  Google Scholar 

  31. Williams RJ 3rd, Laurencin CT, Warren RF, Speciale AC, Brause BD, O’Brien S (1997) Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Diagnosis and management. Am J Sports Med 25:261–267

    Article  Google Scholar 

Download references

Funding

No sources of funding for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Columbia University Medical Center, 633 West 168th Street, PH-11, New York, NY, 10033, USA

    Venkat Boddapati

  2. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Michael C. Fu, Benedict U. Nwachukwu, Andrea M. Spiker, Riley J. Williams & Anil S. Ranawat

  3. Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA

    Christopher L. Camp

Authors
  1. Venkat Boddapati
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael C. Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benedict U. Nwachukwu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christopher L. Camp
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrea M. Spiker
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Riley J. Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anil S. Ranawat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Venkat Boddapati.

Ethics declarations

Conflict of interest

Dr. Ranawat reports royalties from Conformis, consulting fees from Stryker, and Arthrex, outside the submitted work. No other authors have financial disclosures.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

This study utilized de-identified publicly available data and therefore formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boddapati, V., Fu, M.C., Nwachukwu, B.U. et al. Procedure length is independently associated with overnight hospital stay and 30-day readmission following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 28, 432–438 (2020). https://doi.org/10.1007/s00167-019-05622-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-019-05622-z

Keywords

Search

Navigation