Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio.
J Arthroplasty. 2018 Aug;33(8):2616-2622. doi: 10.1016/j.arth.2018.03.012. Epub 2018 Mar 13.
Although previous studies have shown that prolonged operative times can lead to an increased risk of complications after total knee arthroplasty (TKA), they only evaluated a few complications. It is also unclear whether a distinctive operative time exists after which complications increase. Therefore, this study was performed to (1) assess whether higher operative time increases the risk of complications within 30 days of TKA and (2) explore the relationship between operative time and various complications to identify possible operative times where complication rates increase.
The National Surgical Quality Improvement Project database was queried from 2011 to 2015 to identify 140,199 primary TKAs. The effect of operative time (skin-to-skin) on various medical and surgical complications within 30 days was evaluated using multivariable logistic regression models. Spline regression models were created to further study the relationship between operative time and complications.
After adjusting for confounding factors, longer operative times were associated with higher risks of readmission (P < .001), reoperation (P < .001), surgical site infection (P < .001), wound dehiscence (P < .001), and transfusion (P < .001). The majority of the complications demonstrated an increase throughout the range of operative time, with a slightly pronounced increase in the risk of complications when the operative time was longer than 80 minutes.
Prolonged operative times were associated with an increased risk of a number of important complications such as readmissions, reoperations, surgical site infections, and wound complications. Based on our results, an operative time goal of less than 80 minutes is helpful for minimizing these complications after TKA.
尽管先前的研究表明，全膝关节置换术（TKA）后手术时间延长会增加并发症的风险，但这些研究仅评估了几种并发症。目前尚不清楚是否存在一个独特的手术时间点，超过该时间点后并发症的发生率会增加。因此，本研究旨在：（1）评估手术时间延长是否会增加 TKA 后 30 天内发生并发症的风险；（2）探讨手术时间与各种并发症之间的关系，以确定可能导致并发症发生率增加的手术时间点。
本研究通过查询 2011 年至 2015 年国家外科质量改进计划数据库，确定了 140199 例初次 TKA。使用多变量逻辑回归模型评估手术时间（皮肤到皮肤）对 30 天内各种医疗和手术并发症的影响。创建样条回归模型进一步研究手术时间与并发症之间的关系。
在调整了混杂因素后，较长的手术时间与更高的再入院风险（P <.001）、再次手术风险（P <.001）、手术部位感染风险（P <.001）、伤口裂开风险（P <.001）和输血风险（P <.001）相关。大多数并发症在整个手术时间范围内呈增加趋势，当手术时间超过 80 分钟时，并发症风险的增加更为明显。
手术时间延长与多种重要并发症（如再入院、再次手术、手术部位感染和伤口并发症）的风险增加相关。根据我们的结果，手术时间目标小于 80 分钟有助于降低 TKA 后这些并发症的发生率。
