Increased Shoulder Arthroscopy Time Is Associated With Overnight Hospital Stay and Surgical Site Infection

V. Boddapati
M. C. Fu
W. W. Schairer
A. S. Ranawat
D. M. Dines, Zucker School of Medicine at Hofstra/Northwell
S. A. Taylor
J. S. Dines

Abstract

© 2017 Arthroscopy Association of North America Purpose: The purpose of this study was to characterize the rates of short-term postoperative complications, readmissions, and overnight hospital stays as a function of shoulder arthroscopy procedure time. A secondary aim of this current study was to identify baseline patient risk factors for adverse outcomes. Methods: This study used the American College of Surgeons National Surgical Quality Improvement Program registry from 2012 to 2015. Shoulder arthroscopy cases were categorized based on operative time, either <45 >minutes, between 45 and 90 minutes, or >90 minutes. The rates of 30-day postoperative complications, readmissions, and overnight hospital stays were compared with bivariate and multivariate analysis. Results: In total, 33,095 shoulder arthroscopy procedures were identified. Of these, 7,027 (21.2%) were <45 >minutes, 16,610 (50.2%) were between 45 and 90 minutes, and 9,458 (28.6%) were >90 minutes. Multivariate analysis identified increased the risk of superficial surgical site infections (SSIs) for procedures lasting between 45 and 90 minutes (odds ratio [OR] = 3.63; P =.036) and for procedures >90 minutes (OR = 4.40; P =.019), compared with procedures <45 minutes.>Furthermore, there was an increased risk of overnight hospital stay for patients who had a shoulder arthroscopy lasting between 45 and 90 minutes (OR = 1.33) and >90 minutes (OR = 2.14), compared with procedures <45 minutes. A body mass index>30 kg/m2was an independent predictor of both overnight hospital stay and superficial SSI (P =.020). Age >60, female gender, American Society of Anesthesiologists class ≥3, and a history of diabetes mellitus, hypertension, or chronic obstructive pulmonary disease were additional predictors of overnight hospital stay (P <.001 for all comparisons, unless otherwise noted). Conclusions: Increased shoulder arthroscopy procedure time is associated with adverse short-term outcomes, particularly superficial SSI and overnight hospital stay. This information may be useful for patient counseling and postoperative risk stratification, as operative time is an easily measured surrogate for surgical complexity or difficulty. Level of Evidence: Retrospective cohort study, Level III.