Longer Surgeries, Lengths of Stay Associated with More Adverse Events

The phrase “adverse event” has been defined variably in the orthopaedic literature, which is one reason identifying the factors associated with such events can be tricky. In the August 16, 2017 edition of The Journal of Bone & Joint Surgery, Millstone et al. go a long way toward pinpointing modifiable factors that boost the risk of adverse events.

Using an institution-wide adverse-event reporting system called OrthoSAVES, the authors analyzed adverse events among 2,146 patients who underwent one of three elective orthopaedic procedures: knee replacement, hip replacement, or spinal fusion. They found an overall adverse event rate of 27%, broken down by surgical site as follows:

• 29% for spine
• 27% for knee
• 25% for hip

The most common adverse events had a low severity grade (1 or 2); the authors suggest that including events typically not viewed as severe (such as urinary retention) is one reason the overall adverse event rate in this study was higher than most previously reported.

The unique finding from this study was that two modifiable factors—length of stay and increasing operative duration—were independently associated with a greater risk of an adverse event. More specifically, the authors found that, regardless of surgical site, each additional 30 minutes of surgery increased the adjusted odds for an adverse event by 13%.

The authors were quick to point out that their findings should not be interpreted as an admonition for surgeons to hurry up. “While operative duration may be a modifiable factor, operating more quickly for spinal or any other procedures may, itself, lead to increased complications,” they wrote. Rather, Millstone et al. suggest that the multiple factors comprising “procedural efficiency” during a surgical hospitalization warrant further investigation.