Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
J Arthroplasty. 2018 Jul;33(7):2256-2262.e4. doi: 10.1016/j.arth.2018.02.037. Epub 2018 Feb 17.
Little is known regarding the impact of operative time on adverse events following arthroplasty. The present study tests for associations between a 15-minute increase in operative time and the occurrence of adverse events following primary total joint arthroplasty.
Patients undergoing primary total hip or knee arthroplasty during 2006-2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program. Operative time (as a continuous variable) was tested for association with perioperative outcomes using multivariate regression. All regressions were adjusted for differences in demographic, comorbidity, and procedural characteristics.
A total of 165,474 patients met inclusion criteria. The mean (±standard deviation) operative time was 91.9 ± 32.5 minutes. Following adjustment for baseline characteristics, an increase in operative time by 15 minutes increased the risk of anemia requiring transfusion by 9% (95% confidence interval [CI] = 8%-10%, P < .001), wound dehiscence by 13% (95% CI = 8%-19%, P < .001), renal insufficiency by 9% (95% CI = 3%-14%, P < .001), sepsis by 10% (95% CI = 6%-14%, P < .001), surgical site infection by 9% (95% CI = 7%-12%, P < .001), and urinary tract infection by 4% (95% CI = 2%-6%, P < .001). Similarly, an increase in operative time by 15 minutes increased the risk of hospital readmission by 5% (95% CI = 4%-6%, P < .001) and of extended hospital length of stay (≥4 days) by 9% (95% CI = 8%-10%, P < .001).
The present study suggests that greater operative time increases the risk for multiple postoperative complications following total joint arthroplasty. These data suggest that surgeons should consider steps to minimize operative time without compromising the technical components of the surgical procedure.
对于手术时间对关节置换术后不良事件的影响知之甚少。本研究旨在检验手术时间每增加 15 分钟与初次全关节置换术后不良事件发生之间的关联。
在美国外科医师学会国家手术质量改进计划中，确定了 2006 年至 2013 年间接受初次全髋关节或全膝关节置换术的患者。使用多元回归检验手术时间（作为连续变量）与围手术期结果的关系。所有回归均根据人口统计学、合并症和手术特点的差异进行调整。
共有 165474 名患者符合纳入标准。平均（±标准差）手术时间为 91.9 ± 32.5 分钟。在调整基线特征后，手术时间增加 15 分钟，使输血相关贫血的风险增加 9%（95%置信区间 [CI] = 8%-10%，P <.001），伤口裂开的风险增加 13%（95% CI = 8%-19%，P <.001），肾功能不全的风险增加 9%（95% CI = 3%-14%，P <.001），脓毒症的风险增加 10%（95% CI = 6%-14%，P <.001），手术部位感染的风险增加 9%（95% CI = 7%-12%，P <.001），尿路感染的风险增加 4%（95% CI = 2%-6%，P <.001）。同样，手术时间增加 15 分钟，使患者再次住院的风险增加 5%（95% CI = 4%-6%，P <.001），延长住院时间（≥4 天）的风险增加 9%（95% CI = 8%-10%，P <.001）。
本研究表明，手术时间的增加增加了全关节置换术后多种术后并发症的风险。这些数据表明，外科医生应考虑采取措施尽量减少手术时间，而不影响手术过程的技术环节。
