From the Department of Orthopaedic Surgery, University of Illinois, Chicago, IL.
J Am Acad Orthop Surg Glob Res Rev. 2020 Nov;4(11):e20.00043. doi: 10.5435/JAAOSGlobal-D-20-00043.
Total hip and knee arthroplasties are two of the most commonly performed orthopaedic surgeries and are expected to increase in incidence in the coming decades. We sought to examine whether the duration of these procedures is related to various postoperative complications using data from 2010 to 2017 from the American College of Surgeons National Surgical Quality Improvement Program database.
The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing total hip and knee arthroplasty by their respective Current Procedural Terminology codes. Operation time was stratified into four quartiles with equal sample sizes in each quartile for total hip and knee arthroplasty separately. The first quartile of surgical times was used as the control to which the other three quartiles were compared. Multivariate logistic regression analysis was performed on all samples that accounted for possible covariates, totaling 119,076 patients for total hip and 189,297 for total knee arthroplasty.
The third and fourth quartiles of total hip and total knee arthroplasty were markedly associated with higher incidences of wound complications, particularly infection and dehiscence. In addition, prolonged total hip arthroplasty was associated with a markedly higher rate of urinary tract infections for the third and fourth quartiles, and deep vein thrombosis in the fourth quartile.
The surgical duration of total hip and knee arthroplasties is an independent risk factor for wound complications and several other important postoperative complications. Therefore, extensive preoperative planning and postoperative prophylactic measures should be performed to minimize patient morbidity and reduce hospital costs.
全髋关节和全膝关节置换术是最常进行的两种矫形外科手术，预计在未来几十年发病率将会增加。我们试图利用美国外科医师学会全国手术质量改进计划数据库 2010 年至 2017 年的数据，研究这些手术的持续时间与各种术后并发症之间的关系。
通过各自的当前操作术语代码，从美国外科医师学会全国手术质量改进计划数据库中查询接受全髋关节和全膝关节置换术的患者。手术时间分为四个四分位组，每个四分位组的样本量相等，分别用于全髋关节和全膝关节置换术。将第一四分位的手术时间作为对照组，与其他三个四分位进行比较。对所有考虑到可能的混杂因素的样本进行多变量逻辑回归分析，全髋关节共 119076 例，全膝关节 189297 例。
全髋关节和全膝关节置换术的第三和第四四分位与伤口并发症（特别是感染和裂开）的发生率明显增加有关。此外，全髋关节置换术的手术时间延长与第三和第四四分位的尿路感染率明显增加以及第四四分位的深静脉血栓形成有关。
全髋关节和全膝关节置换术的手术持续时间是伤口并发症和其他几个重要术后并发症的独立危险因素。因此，应进行广泛的术前规划和术后预防措施，以最大限度地减少患者的发病率和降低医院成本。
