Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
J Arthroplasty. 2020 Mar;35(3):621-627. doi: 10.1016/j.arth.2019.10.054. Epub 2019 Nov 2.
Changes in reimbursement in total knee arthroplasty (TKA) by Centers for Medicare and Medicaid Services (CMS) have been tied to a perceived decrease in the total surgical time required to perform these operations. However, little information is available to CMS about recorded surgical times for TKA across the United States and the variables that drive these values. Therefore, the purpose of our study, is to evaluate (1) changes in operative time over time and (2) factors associated with variations in operative time.
The National Surgical Quality Improvement Program database was queried to identify all primary TKAs conducted between January 1, 2008, and December 31, 2017. All TKAs conducted within our study period that had operative time data available were included. Multivariable linear models were created to assess factors that influence operative time over the study period.
Our final analysis included 140,890 TKAs. The mean operative time across the study period was found to be 92.60 minutes. Examining quarterly values, operative time stayed within 5 minutes of this mean (range, 89.80-97.51 minutes). Age, sex, functional status, anesthesia type, body mass index, operative year, transfusion requirements, and preoperative laboratory findings significantly influenced operative time (P < .05 for all).
Our analysis indicates that while there are numerous factors that influence procedure duration, operative times have remained stable. This information should be heavily considered in regard to physician reimbursement, because providers are maintaining operative times and work effort while mitigating factors that influence outcomes in the perioperative period.
医疗保险和医疗补助服务中心 (CMS) 对全膝关节置换术 (TKA) 的报销政策的改变与人们认为这些手术所需的总手术时间减少有关。然而，CMS 几乎没有关于美国各地 TKA 记录的手术时间以及影响这些时间的变量的信息。因此，我们研究的目的是评估 (1) 手术时间随时间的变化，以及 (2) 与手术时间变化相关的因素。
国家手术质量改进计划数据库被查询，以确定 2008 年 1 月 1 日至 2017 年 12 月 31 日期间进行的所有初次 TKA。在我们的研究期间，所有具有手术时间数据的 TKA 都包括在内。多变量线性模型被创建来评估在研究期间影响手术时间的因素。
我们的最终分析包括 140890 例 TKA。整个研究期间的平均手术时间为 92.60 分钟。检查季度值，手术时间在该平均值的 5 分钟范围内（范围为 89.80-97.51 分钟）。年龄、性别、功能状态、麻醉类型、体重指数、手术年份、输血需求和术前实验室检查结果显著影响手术时间（所有 P<0.05）。
我们的分析表明，虽然有许多因素影响手术持续时间，但手术时间一直保持稳定。在考虑医生报酬时，应该充分考虑这些信息，因为提供者在减轻围手术期影响结果的因素的同时，保持手术时间和工作效率。
