Recent surgery, operative times increase complications of knee arthroscopy

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1. Patients who have undergone a recent surgical procedure (within 30 days) are at increased risk for a major morbidity following elective knee arthroscopy. 

2. Operative times of greater than 1.5 hours increase the risk of major morbidity in patients that undergo elective knee arthroscopy. 

Study Rundown:  Knee arthroscopy is a minimally invasive procedure used to treat ligamentous, soft tissue or bone pathology with a high rate of success.  Although the complication rate for elective knee arthroscopy is exceedingly low, its extensive utilization calls for accurate identification and quantification of postoperative complication risks.  This study identified patients who have undergone a separate surgical procedure within the past 30 days as being at enhanced risk for major postoperative complications.  Operative time greater than 1.5 hours also places patients at increased risk for postoperative complications.  Each of these findings should be considered by orthopaedic surgeons during preoperative planning in order to minimize postoperative morbidity.  This study does not address long-term outcomes and is limited to complications that occurred within the first 30 days after a procedure.  Additionally, subjective complaints such as range of motion and pain are not addressed by this study.  Nonetheless, this study provides a quantitative and generalizable account of the complications seen following knee arthroscopy and can be used to guide future efforts to reduce them.

Click to read the study in the Journal of Bone and Joint Surgery

Relevant Reading: Complications of arthroscopy of the knee

In-Depth [retrospective study]: This study included 12,271 patients who underwent elective knee arthroscopy from January 2005 to December 2010.  Data was collected at over 258 US hospitals through the American College of Surgeons National Surgical Quality Improvement Program(ACS NSQIP), a centralized maintained database.  CPT procedure codes were used to retrospectively query this database for arthroscopic procedures, risk factors, and outcomes.  Arthroscopic interventions were subdivided into major or minor procedures with major procedures including ACL reconstruction, meniscal transplant, osteochondral autograft, and PCL reconstruction.  Postoperative 30-day complications were categorized as major morbidity such as mortality risks and vital organ injury, or minor morbidity such as low-risk events localized to the extremity or surgical site.

The overall incidence of any complication was 1.6% (199/12271) with 0.76% (93/12276) major complications and 0.86% (106/12271) minor complications.  No difference in complication rate was found between major and minor procedures.  Multivariate analysis identified the following independent risk factors for major morbidity/mortality:  prior operation within 30 days (OR 14.25), operative time of >1.5hrs (OR 1.99), advanced patient age(OR 2.04) preoperative dyspnea (OR 3.13) and a history of bleeding disorders (OR 3.79).  Black race, recent weight loss, and operative time >1.5hrs were each found to be independent risk factors for minor morbidity.

By Chaz Carrier and  Allen Ho

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