Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA.
Shoulder and Elbow Center, Sports Medicine Center, OrthoCarolina, Charlotte, NC, USA.
J Shoulder Elbow Surg. 2020 Apr;29(4):807-813. doi: 10.1016/j.jse.2019.08.015. Epub 2019 Oct 31.
Surgical duration is an independent predictor of short-term adverse outcomes after a variety of orthopedic procedures, both arthroscopic and open. However, this association in shoulder arthroplasty remains unclear. The purpose of this study was to identify the association between surgical duration and postoperative complications, as well as increased use of health care resources, after shoulder arthroplasty.
Primary shoulder arthroplasty procedures performed from 2005 to 2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology codes. Surgical duration was divided into 3 cohorts: (1) surgical procedures lasting less than 90 minutes, (2) those lasting between 90 and 120 minutes, and (3) those lasting more than 120 minutes. Baseline patient characteristics and outcome variables were compared using bivariate analysis. Outcome variables were compared using multivariate analysis.
Overall, 14,106 patients were identified. Longer surgical duration was significantly associated with younger age, male patients, higher body mass index, and use of general anesthesia, (P < .001 for each), as well as smoking history (P < .39). Relative to operative times shorter than 90 minutes, surgical procedures lasting more than 120 minutes had higher rates of any complication (P = .002), return to the operating room (P = .008), urinary tract infection (P = .02), non-home discharge (P < .001), blood transfusion (P < .001), and unplanned 30-day hospital readmission (P = .03).
Increasing surgical duration was associated with a variety of postoperative medical complications and increased use of health care resources including discharge to acute care facilities, blood transfusions, and hospital readmission. These data suggest that surgical duration should be considered for postoperative risk stratification, as well as patient counseling, and may be a surgeon-modifiable risk factor independent of patient risk factors.
手术时间是各种骨科手术（包括关节镜手术和开放手术）短期不良结果的独立预测因素。然而，在肩关节置换术中，这种关联尚不清楚。本研究的目的是确定肩关节置换术后手术时间与术后并发症以及医疗资源使用增加之间的关系。
在美国外科医师学会国家手术质量改进计划数据库中，使用当前手术术语代码确定 2005 年至 2016 年期间进行的原发性肩关节置换术。将手术时间分为 3 个队列：（1）手术时间小于 90 分钟；（2）手术时间在 90 至 120 分钟之间；（3）手术时间超过 120 分钟。使用双变量分析比较基线患者特征和结局变量。使用多变量分析比较结局变量。
总体而言，共确定了 14106 名患者。手术时间较长与年龄较小、男性患者、较高的体重指数和全身麻醉的使用显著相关（P <.001），以及吸烟史（P <.39）。与手术时间短于 90 分钟相比，手术时间超过 120 分钟的患者出现任何并发症的比例较高（P =.002），需要再次手术的比例较高（P =.008），尿路感染的比例较高（P =.02），非居家出院的比例较高（P <.001），输血的比例较高（P <.001），以及计划外 30 天内再次住院的比例较高（P =.03）。
手术时间的延长与各种术后医疗并发症以及医疗资源使用的增加有关，包括转至急性护理机构、输血和住院再入院。这些数据表明，手术时间应考虑用于术后风险分层以及患者咨询，并且可能是独立于患者风险因素的可改变的手术因素。
