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International Orthopaedics

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01-10-2018 | Original Paper

Impact of surgical case order on peri-operative outcomes for total joint arthroplasty

Authors: Xiang Li, Qi Zhang, Jiyuan Dong, Guoqiang Zhang, Wei Chai, Jiying Chen

Published in: International Orthopaedics | Issue 10/2018

Abstract

Introduction

There is growing support in the literatures that peri-operative outcomes are adversely affected by surgical case order in some certain surgical procedures. This study aimed to examine if similar phenomenon is also shared in total joint arthroplasty (TJA).

Methods

A total of 6548 joints (5183 patients) treated with primary TJA by a total of five surgeons at our institution from December 2011 to December 2015 were retrospectively reviewed in this study. Demographic data, operative duration, blood loss, peri-operative adverse events, medical cost, and length of hospital stay were collected and analyzed. Logistic regression was used to determine risk factors for adverse events.

Results

Of the 6548 cases in this cohort, 1643 TJAs were classified as first round cases, 1744 TJAs were second round cases, 1600 TJAs were third round cases, and 1561 TJAs were fourth or later round cases. Mean operating time was shorter in the intermediate cases (45.0 vs. 41.0 vs. 41.8 vs. 54.1 min, P < 0.01). Peri-operative arthroplastic adverse events were increased in later surgical cases (2.07% vs. 2.18% vs. 3.06% vs. 4.87%, P < 0.01). Later case order (OR = 1.40 [95% CI: 1.22–1.61], P < 0.01) was a significant risk factor of arthroplastic adverse events. Patients undergoing TJA later in the day were more likely to have longer length of stay and higher cost than earlier cases. Peri-operative systemic complications and blood loss did not significantly differ between groups.

Conclusion

Surgical case order is an independent risk factor for arthroplastic adverse events in TJA. TJA procedures performed later in the day have a higher risk for arthroplastic adverse events, but not for systematic adverse events. Significantly increased operative time, higher cost, and longer LOS were noted for fourth or later TJA cases. Data in our study reveals that performing more than three TJAs within a single day may imply compromised outcomes.

Kane RL, Saleh KJ, Wilt TJ, Bershadsky B (2005) The functional outcomes of total knee arthroplasty. J Bone Joint Surg Am 87(8):1719–1724. https://doi.org/10.2106/JBJS.D.02714 CrossRefPubMed

Carr AJ, Robertsson O, Graves S, Price AJ, Arden NK, Judge A, Beard DJ (2012) Knee replacement. Lancet 379(9823):1331–1340. https://doi.org/10.1016/S0140-6736(11)60752-6 CrossRef

Pivec R, Johnson AJ, Mears SC, Mont MA (2012) Hip arthroplasty. Lancet 380(9855):1768–1777. https://doi.org/10.1016/S0140-6736(12)60607-2 CrossRefPubMed

Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Simonsen O, Rasmussen S (2015) A randomized, controlled trial of Total knee replacement. N Engl J Med 373(17):1597–1606. https://doi.org/10.1056/NEJMoa1505467 CrossRef

Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M (2005) Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 87(7):1487–1497. https://doi.org/10.2106/JBJS.D.02441 CrossRefPubMed

Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785. https://doi.org/10.2106/JBJS.F.00222 CrossRef

Singh JA, Vessely MB, Harmsen WS, Schleck CD, Melton LJ 3rd, Kurland RL, Berry DJ (2010) A population-based study of trends in the use of total hip and total knee arthroplasty, 1969-2008. Mayo Clin Proc 85(10):898–904. https://doi.org/10.4065/mcp.2010.0115 CrossRefPubMedPubMedCentral

Kelz RR, Freeman KM, Hosokawa PW, Asch DA, Spitz FR, Moskowitz M, Henderson WG, Mitchell ME, Itani KM (2008) Time of day is associated with postoperative morbidity: an analysis of the national surgical quality improvement program data. Ann Surg 247(3):544–552. https://doi.org/10.1097/SLA.0b013e31815d7434 CrossRefPubMed

Thomas AA, Kim B, Derboghossians A, Chang A, Finley DS, Chien GW, Slezak J, Jacobsen SJ (2014) Impact of surgical case order on perioperative outcomes for robotic-assisted radical prostatectomy. Urol Ann 6(2):142–146. https://doi.org/10.4103/0974-7796.130645 CrossRefPubMedPubMedCentral

10.

Gupta D, Taravati P (2015) Effect of surgical case order on cataract surgery complication rates and procedure time. J Cataract Refract Surg 41(3):594–597. https://doi.org/10.1016/j.jcrs.2014.06.032 CrossRefPubMed

11.

Govindarajan A, Urbach DR, Kumar M, Li Q, Murray BJ, Juurlink D, Kennedy E, Gagliardi A, Sutradhar R, Baxter NN (2015) Outcomes of daytime procedures performed by attending surgeons after night work. N Engl J Med 373(9):845–853. https://doi.org/10.1056/NEJMsa1415994 CrossRefPubMed

12.

Kahol K, Leyba MJ, Deka M, Deka V, Mayes S, Smith M, Ferrara JJ, Panchanathan S (2008) Effect of fatigue on psychomotor and cognitive skills. Am J Surg 195(2):195–204. https://doi.org/10.1016/j.amjsurg.2007.10.004 CrossRefPubMed

13.

Peskun C, Walmsley D, Waddell J, Schemitsch E (2012) Effect of surgeon fatigue on hip and knee arthroplasty. Can J Surg 55(2):81–86. https://doi.org/10.1503/cjs.032910 CrossRefPubMedPubMedCentral

14.

Nadler SB, Hidalgo JH, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51(2):224–232

15.

Sehat KR, Evans R, Newman JH (2000) How much blood is really lost in total knee arthroplasty?. Correct blood loss management should take hidden loss into account. Knee 7(3):151–155CrossRef

16.

Administration FaD (2014) What is a serious adverse event?. http://www.fda.gov/Safety/MedWatch/HowToReport/ucm053087.htm

17.

Basques BA, Toy JO, Bohl DD, Golinvaux NS, Grauer JN (2015) General compared with spinal anesthesia for total hip arthroplasty. J Bone Joint Surg Am 97(6):455–461. https://doi.org/10.2106/JBJS.N.00662 CrossRefPubMedPubMedCentral

18.

Nwachukwu BU, Dy CJ, Burket JC, Padgett DE, Lyman S (2015) Risk for complication after Total joint arthroplasty at a Center of Excellence: the impact of patient travel distance. J Arthroplast 30(6):1058–1061. https://doi.org/10.1016/j.arth.2015.01.015 CrossRef

19.

Kahol K, Satava RM, Ferrara J, Smith ML (2009) Effect of short-term pretrial practice on surgical proficiency in simulated environments: a randomized trial of the "preoperative warm-up" effect. J Am Coll Surg 208(2):255–268. https://doi.org/10.1016/j.jamcollsurg.2008.09.029 CrossRefPubMed

20.

Willis-Owen CA, Konyves A, Martin DK (2010) Factors affecting the incidence of infection in hip and knee replacement: an analysis of 5277 cases. J Bone Joint Surg Br 92(8):1128–1133. https://doi.org/10.1302/0301-620X.92B8.24333 CrossRefPubMed

21.

Kapadia BH, Berg RA, Daley JA, Fritz J, Bhave A, Mont MA (2016) Periprosthetic joint infection. Lancet 387(10016):386–394. https://doi.org/10.1016/S0140-6736(14)61798-0 CrossRefPubMed

22.

Chen AF, Kheir MM, Greenbaum JM, Restrepo C, Maltenfort MG, Parvizi J (2017) Surgical case order has an effect on the risk of subsequent Periprosthetic joint infection. J Arthroplast 32(7):2234–2238. https://doi.org/10.1016/j.arth.2017.02.029 CrossRef

23.

Gorenoi V, Schonermark MP, Hagen A (2009) Arthroplasty register for Germany. GMS Health Technol Assess 5:Doc13. https://doi.org/10.3205/hta000075 CrossRefPubMedPubMedCentral

24.

Hunt LP, Ben-Shlomo Y, Clark EM, Dieppe P, Judge A, MacGregor AJ, Tobias JH, Vernon K, Blom AW, National Joint Registry for E, Wales (2014) 45-day mortality after 467,779 knee replacements for osteoarthritis from the National Joint Registry for England and Wales: an observational study. Lancet 384(9952):1429–1436. https://doi.org/10.1016/S0140-6736(14)60540-7 CrossRefPubMed

25.

Hunt LP, Ben-Shlomo Y, Clark EM, Dieppe P, Judge A, MacGregor AJ, Tobias JH, Vernon K, Blom AW, National Joint Registry for England W, Northern I (2013) 90-day mortality after 409,096 total hip replacements for osteoarthritis, from the National Joint Registry for England and Wales: a retrospective analysis. Lancet 382(9898):1097–1104. https://doi.org/10.1016/S0140-6736(13)61749-3 CrossRefPubMed

26.

National Joint Registry for England WaNI (2014) The National Joint Registry Annual Report 2014

27.

University L (2015) Swedish Knee Arthroplasty Register Annual report 2015

28.

Bagrodia A, Rachakonda V, Delafuente K, Toombs S, Yeh O, Scales J, Roehrborn CG, Lotan Y (2012) Surgeon fatigue: impact of case order on perioperative parameters and patient outcomes. J Urol 188(4):1291–1296. https://doi.org/10.1016/j.juro.2012.06.021 CrossRefPubMed

29.

Schieman C, MacLean AR, Buie WD, Rudmik LR, Ghali WA, Dixon E (2008) Does surgeon fatigue influence outcomes after anterior resection for rectal cancer? Am J Surg 195(5):684–687; discussion 687-688. https://doi.org/10.1016/j.amjsurg.2008.01.009 CrossRefPubMed

30.

Sturm L, Dawson D, Vaughan R, Hewett P, Hill AG, Graham JC, Maddern GJ (2011) Effects of fatigue on surgeon performance and surgical outcomes: a systematic review. ANZ J Surg 81(7–8):502–509CrossRef

31.

Beredjiklian JGPK (2007) Core knowledge in Orthopaedics: adult reconstruction and arthroplasty. Mosby, Philadelphia

32.

Kim YH, Kwon OR, Kim JS (2009) Is one-stage bilateral sequential total hip replacement as safe as unilateral total hip replacement? J Bone Joint Surg Br 91(3):316–320. https://doi.org/10.1302/0301-620X.91B3.21817 CrossRefPubMed

33.

Stavrakis AI, SooHoo NF, Lieberman JR (2015) Bilateral Total hip arthroplasty has similar complication rates to unilateral Total hip arthroplasty. J Arthroplast 30(7):1211–1214. https://doi.org/10.1016/j.arth.2015.02.015 CrossRef

Title: Impact of surgical case order on peri-operative outcomes for total joint arthroplasty
Authors: Xiang Li
Qi Zhang
Jiyuan Dong
Guoqiang Zhang
Wei Chai
Jiying Chen
Publication date: 01-10-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 10/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-3835-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Impact of surgical case order on peri-operative outcomes for total joint arthroplasty

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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