Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.
J Arthroplasty. 2019 Nov;34(11):2569-2572. doi: 10.1016/j.arth.2019.06.029. Epub 2019 Jun 18.
High-quality care is essential in total joint arthroplasty. Multiple initiatives such as centers of excellence, patient optimization, and alternative payment models have demonstrated improved outcomes and decreased cost. Many studies have shown that longer operative times (OTs) are associated with increased frequency of postoperative complications. These findings often come from large data sets and may not accurately represent the average OT of individual surgeons. The purpose of this study was to determine the hospital and patient-related factors that influence OT.
This retrospective study reviewed OT of 6003 total knee arthroplasty cases performed by 41 surgeons at 4 hospitals in a single health-care system. Mean OT was calculated for each surgeon. The effect of surgeon, hospital-, and patient-related factors on OT was assessed.
Among the 41 surgeons, the mean OT was 105 ± 25 minutes. Two community hospitals had significantly faster OT compared with the tertiary care academic hospital. Surgeons' OT for morbidly obese patients was significantly longer compared with normal, overweight, and obese patients. Surgeon volume, surgeon experience, trainee presence, and American Society of Anesthesiologists status did not significantly affect surgical time.
Operative time was influenced by hospital-related (tertiary, community) and patient-related (morbid obesity vs lower body mass index groups) factors. However, specific surgeon factors (surgical volume, experience), surgical team factors (presence or absence of trainee), and patient factors (American Society of Anesthesiologists status) did not significantly alter the OT. Additional studies of larger health systems are needed to examine additional patient, surgeon, and hospital factors which may influence the OT.
高质量的医疗护理在全关节置换术中至关重要。多个项目，如卓越中心、患者优化和替代支付模式，已证明可改善结果并降低成本。许多研究表明，手术时间较长与术后并发症的发生频率增加有关。这些发现通常来自大型数据集，可能无法准确反映每位外科医生的平均手术时间。本研究旨在确定影响手术时间的医院和患者相关因素。
这是一项回顾性研究，对单一医疗系统的 4 家医院的 41 名外科医生进行的 6003 例全膝关节置换术的手术时间进行了回顾。计算每位外科医生的平均手术时间。评估外科医生、医院和患者相关因素对手术时间的影响。
在 41 名外科医生中，平均手术时间为 105 ± 25 分钟。两家社区医院的手术时间明显快于三级保健学术医院。病态肥胖患者的外科医生手术时间明显长于正常、超重和肥胖患者。外科医生的手术量、经验、受训者的存在以及美国麻醉医师协会的状态并没有显著影响手术时间。
手术时间受到医院相关（三级、社区）和患者相关（病态肥胖与较低身体质量指数组）因素的影响。然而，特定外科医生因素（手术量、经验）、手术团队因素（是否有受训者）和患者因素（美国麻醉医师协会状态）并没有显著改变手术时间。需要对更大的医疗系统进行进一步的研究，以检查可能影响手术时间的其他患者、外科医生和医院因素。
