Summary

A retrospective review of a data collected through a prospective, multicenter surgeon-driven quality improvement registry to determine whether operative time is an independent risk factor for developing complications following ACL reconstruction in skeletally immature patients.

Abstract

Introduction

As the incidence of ACL reconstructions has increased dramatically in skeletally immature patients, there is a growing interest in identifying and minimizing complications for these patients.1,2 Although the adult ACL literature has demonstrated an association between operative time and risk of complications,3 this has not been studied in skeletally immature patients. The purpose of this study was to determine whether operative time is an independent risk factor for developing complications following ACL reconstruction in skeletally immature patients.

Hypothesis

Increased operative time is associated with an increased risk of complications following ACL reconstruction in skeletally immature children and adolescents.

Methods

A prospective, multicenter surgeon-driven quality improvement registry was reviewed to identify skeletally immature patients who underwent a primary isolated ACL reconstruction, with minimum 8-month follow-up. Demographics, surgical characteristics, operative time, and complications were recorded. Continuous variables were compared via independent t-test or ANOVA, and categorical variables were compared via Chi-squared test. Multiple logistic regression analysis was performed to control for demographic and surgical characteristics. Significance was set at p < 0.05.

Results

Preoperative Characteristics
A total of 711 patients, from a registry of 9,532 patients at the time of analysis, were included with mean follow-up of 17.6 ± 8.6 months (range 8-30 months). Mean age was 13.2 ± 1.9 years and mean operative time was 112.3 ± 38.8 minutes. Obese patients (OR = 1.22, p < 0.001), patients who received only regional anesthesia (OR = 1.55, p < 0.001), and patients without a tourniquet placed during surgery (OR = 1.37, p < 0.001) all experienced longer operative times.

Complications
The complication rate for the cohort was 15.19%. Patients who developed a complication had an approximately 12-minute longer operative time versus patients who did not develop a complication (122.3 ± 38.8 vs. 110.5 ± 35.5 minutes, p = 0.002). After adjusting for demographic and surgical characteristics, increased operative time remained an independent risk factor for developing a complication (OR = 1.16, p = 0.001). Specifically, increased operative time was an independent risk factor for surgical site infection (OR = 1.24, p = 0.042) and arthrofibrosis (OR = 1.31, p = 0.006).

Discussion

Increased operative time was associated with an increased risk of developing surgical complications following ACL reconstruction for skeletally immature patients, when controlling for demographic and perioperative characteristics. Specifically, increased operative time was associated with surgical site infection and arthrofibrosis. Future efforts to increase operative efficiency are warranted to reduce operative time and thereby improve patient outcomes.