From the Division of Orthopaedic Surgery, Western University, London, Ont. (Morcos); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Nowak); and the London Health Sciences Centre, London, Ont. (Schemitsch).
Can J Surg. 2021 Apr 28;64(3):E273-E279. doi: 10.1503/cjs.002720.
The aim of this study was to evaluate the influence of operating time on complications and readmission within 30 days of total knee arthroplasty (TKA) and to determine if there were specific time intervals associated with worse outcomes.
The American College of Surgeons’ National Surgical Quality Improvement Program database was used to identify patients 18 years of age and older who underwent TKA between 2006 and 2017, using procedural codes. Patient demographic characteristics, operation length and 30-day major and minor complication and readmission rates were captured. We used multivariable regression to determine if the rates of complications and readmission differed depending on the length of the operation, while adjusting for relevant covariables.
A total of 263 174 patients who underwent TKA were identified from the database. Their mean age was 66.8 (standard deviation 9.7) years. Within 30 days of the index procedure, 5700 patients (2.2%) experienced a major complication, 5185 (2.0%) experienced a minor complication and 7730 (3.1% of 249 746 patients from 2011 to 2017) were readmitted. Mean operation length was 91.7 minutes (range 30–240 min). After adjustment for relevant covariables, an operating time of 90 minutes or more was a significant predictor of major and minor complications as well as readmission. There was no difference in the odds of complications or readmission for operations lasting 30–49, 50–69 or 70–89 minutes (p > 0.05).
Our data suggest that operating times of 90 minutes or more may be associated with an increase in the 30-day odds of complications and readmission following TKA. Further studies are needed to confirm our findings and determine the influence of surgical time on outcomes when there is increased case complexity.
本研究旨在评估全膝关节置换术（TKA）后 30 天内手术时间对并发症和再入院的影响，并确定是否存在与不良结果相关的特定时间间隔。
使用美国外科医师学院国家手术质量改进计划数据库，通过程序代码确定 2006 年至 2017 年间接受 TKA 的 18 岁及以上患者。捕获患者人口统计学特征、手术时长以及 30 天内主要和次要并发症及再入院率。我们使用多变量回归来确定在调整相关协变量的情况下，手术时间的长短是否会导致并发症和再入院率的差异。
从数据库中确定了 263174 例接受 TKA 的患者。他们的平均年龄为 66.8（标准差 9.7）岁。在索引手术的 30 天内，5700 例患者（2.2%）发生重大并发症，5185 例患者（2.0%）发生轻微并发症，7730 例患者（2011 年至 2017 年 249746 例患者的 3.1%）再入院。平均手术时间为 91.7 分钟（范围 30-240 分钟）。在调整相关协变量后，手术时间 90 分钟或以上是重大和轻微并发症以及再入院的显著预测因素。手术时间为 30-49、50-69 或 70-89 分钟的患者，并发症或再入院的几率没有差异（p>0.05）。
我们的数据表明，TKA 后手术时间 90 分钟或以上可能与 30 天内并发症和再入院的几率增加相关。需要进一步的研究来证实我们的发现，并确定手术时间对手术复杂性增加时结果的影响。
