Abstract
Background
This study aimed to clarify the impact of various factors on the operating time, postoperative complications, and length of stay (LOS) after total knee arthroplasty (TKA).
Methods
We identified 3577 TKAs performed in 345 hospitals in Japan from November 2006 to March 2007. We examined the patient characteristics, surgical procedure details, hospital and surgeon volumes, and outcome variables (operating time, postoperative complications, LOS).
Results
The average operating time was 127 ± 47 min. The rate of postoperative complications was 9.8%. The average LOS was 35.1 ± 15.9 days. In multivariate regression analyses, the average operating times were significantly shorter at hospitals with >10 cases per year compared to hospitals with <10 cases per year and for surgeons with ≥100 total cases compared to surgeons with <100 total cases. A longer operating time was associated with revision surgery and use of computer navigation. Significant predictors of postoperative complications were age, body mass index, and cerebrovascular disease. Shorter LOS was associated with higher hospital volume and use of a clinical pathway, whereas age, cardiovascular disease, and revision surgery increased the length of stay.
Conclusions
Postoperative complications following TKA mainly depended on patient-based factors and were not significantly affected by the surgeon’s experience.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty: a qualitative and systematic review of the literature. J Bone Joint Surg Am 2004;86:963–974.
Tashiro Y, Miura H, Matsuda S, Okazaki K, Iwamoto Y. Minimally invasive versus standard approach in total knee arthroplasty. Clin Orthop 2007;463:144–150.
King J, Stamper DL, Schaad DC, Leopold SS. Minimally invasive total knee arthroplasty compared with traditional total knee arthroplasty: assessment of the learning curve and the postoperative recuperative period. J Bone Joint Surg Am 2007;89:1497–1503.
Chen AF, Alan RK, Redziniak DE, Tria AJ Jr. Quadriceps sparing total knee replacement: the initial experience with results at two to four years. J Bone Joint Surg Br 2006;88:1448–1453.
Haas SB, Cook S, Beksac B. Minimally invasive total knee replacement through a mini midvastus approach: a comparative study. Clin Orthop 2004;428:68–73.
Sugano N. Computer-assisted orthopedic surgery. J Orthop Sci 2003;8:442–448.
Bäthis H, Perlick L, Tingart M, Lüring C, Zurakowski D, Grifka J. Alignment in total knee arthroplasty: a comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br 2004;86:682–687.
Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A. Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop 2005;433:152–159.
Dutton AQ, Yeo SJ, Yang KY, Lo NN, Chia KU, Chong HC. Computer-assisted minimally invasive total knee arthroplasty compared with standard total knee arthroplasty: a prospective, randomized study. J Bone Joint Surg Am 2008;90:2–9.
Shervin N, Rubash HE, Katz JN. Orthopaedic procedure volume and patient outcomes: a systematic literature review. Clin Orthop 2007;457:35–41.
Hervey SL, Purves HR, Guller U, Toth AP, Vail TP, Pietrobon R. Provider volume of total knee arthroplasties and patient outcomes in the HCUP-nationwide inpatient sample. J Bone Joint Surg Am 2003;85:1775–1783.
SooHoo NF, Lieberman JR, Ko CY, Zingmond DS. Factors predicting complication rates following total knee replacement. J Bone Joint Surg Am 2006;88:480–485.
Katz JN, Barrett J, Mahomed NN, Baron JA, Wright RJ, Losina E. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am 2004;86:1909–1916.
Kreder HJ, Grosso P, Williams JI, Jaglal S, Axcell T, Wal EK, et al. Provider volume and other predictors of outcome after total knee arthroplasty: a population study in Ontario. Can J Surg 2003;46:15–22.
Norton EC, Garfinkel SA, McQuay LJ, Heck DA, Wright JG, Dittus R, et al. The effect of hospital volume on the in-hospital complication rate in knee replacement patients. Health Serv Res 1998;33:1191–1210.
Heck DA, Robinson RL, Partridge CM, Lubitz RM, Freund DA. Patient outcomes after knee replacement. Clin Orthop 1998;356:93–110.
Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika 1986;73:13–22.
Author information
Authors and Affiliations
About this article
Cite this article
Yasunaga, H., Tsuchiya, K., Matsuyama, Y. et al. Analysis of factors affecting operating time, postoperative complications, and length of stay for total knee arthroplasty: nationwide web-based survey. J Orthop Sci 14, 10–16 (2009). https://doi.org/10.1007/s00776-008-1294-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00776-008-1294-7