Småbrekke Arvid, Espehaug Birgitte, Havelin Leif I, Furnes Ove
Department of Orthopaedic Surgery, Hammerfest Hospital, Sykehusveien 35, NO-9600 Hammerfest, Norway.
Acta Orthop Scand. 2004 Oct;75(5):524-32. doi: 10.1080/00016470410001376.
Some studies have found a significant decrease in operating time as a result of standardizing programs for hip surgery. To study the influence of operating time (skin to skin) on survival of total hip replacements, we investigated the operating time in local hospitals in Norway. We have found no other large published series of THRs investigating operating time and revision.
The study was based on 31,745 primary THRs reported to the Norwegian Arthroplasty Register from 47 local hospitals during 1987-2001. Operating time was divided into 7 categories, and for each category separate Kaplan-Meier curves and adjusted failure rate ratios were calculated.
The mean operating time for all local hospitals in Norway was 96 (68-130) min. Increasing operating volume from less than 10 THRs/hospital/year to more than 200 THRs/hospital/year was associated with a 25-min decrease in mean operating time in cemented THRs and a 35-min decrease in the case of uncemented THRs. With the operating time category of 71-90 min as reference category, cemented THRs that lasted more than 150 min had a two-fold increased (95% CI: 1.6-2.6) revision rate. For uncemented implants, the revision rate was 1.3 times higher (95% CI: 0.8-2.2). Cemented implants with operating time under 51 min and over 90 min were associated with an increased risk of revision due to aseptic loosening. Cemented implants with operating time over 150 min were associated with an increased risk of revision due to infection.
Hospitals with long operating times should consider the potential benefit of reducing these times, as this may lead to lower revision rates and increased operating volumes. Shorter operation times could be achieved by standardization programs, but one should bear in mind that for cemented implants very short operating times also increased revision risk due to aseptic loosening.
一些研究发现，由于髋关节手术程序标准化，手术时间显著缩短。为研究手术时间（皮肤切开至缝合）对全髋关节置换术生存率的影响，我们调查了挪威当地医院的手术时间。我们未发现其他已发表的关于全髋关节置换术手术时间及翻修情况的大型系列研究。
本研究基于1987年至2001年期间挪威47家当地医院向挪威关节置换登记处报告的31,745例初次全髋关节置换术病例。手术时间分为7类，针对每一类分别计算了Kaplan-Meier曲线和调整后的失败率比值。
挪威所有当地医院的平均手术时间为96（68 - 130）分钟。将手术量从每年每家医院少于10例全髋关节置换术增加至每年每家医院超过200例全髋关节置换术，骨水泥型全髋关节置换术的平均手术时间减少25分钟，非骨水泥型全髋关节置换术的平均手术时间减少35分钟。以71 - 90分钟的手术时间类别作为参照类别，骨水泥型全髋关节置换术手术时间超过150分钟的翻修率增加了两倍（95%置信区间：1.6 - 2.6）。对于非骨水泥型植入物，翻修率高出1.3倍（95%置信区间：0.8 - 2.2）。手术时间低于51分钟和超过90分钟的骨水泥型植入物因无菌性松动导致翻修的风险增加。手术时间超过150分钟的骨水泥型植入物因感染导致翻修的风险增加。
手术时间长的医院应考虑缩短手术时间可能带来的益处，因为这可能会降低翻修率并增加手术量。通过标准化程序可以实现更短的手术时间，但应牢记，对于骨水泥型植入物，极短的手术时间也会因无菌性松动而增加翻修风险。
