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Low early complication, morbidity rates found after knee arthroscopy
The most common major morbidity was return to the operating room.
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NEW ORLEANS — In a retrospective review of 12,271 patient records obtained from a national database, researchers from the University of Iowa discovered an overall complication rate of less than 2% and a major morbidity rate of less than 1% within 30 days following elective knee arthroscopy.
“Morbidity was low at 1.6% and the risk factors we identified were longer operative times, older patient age, patients who had other recent operations and black race,” said study author Christopher T. Martin, MD, who presented the research at the American Academy of Orthopaedic Surgeons Annual Meeting.
Demographics
Martin and colleagues used data from the American College of Surgeons National Surgical Quality Improvement Program, which contains prospectively collected information from 258 hospitals, to identify knee arthroscopy patients.
The researchers excluded acute trauma cases, patients with preoperative wound contamination and preoperative sepsis. Patients were stratified based on procedure type. “We considered a major procedure to be anything that required a reconstruction or additional incisions about the knee, such as ACL reconstructions or meniscal transplants,” Martin said. “[The] minor procedures were surgeries that did not need additional incisions or that did not require a reconstruction, such as synovectomies or loose body removals,” he said. There were approximately 2,000 major and 10,000 minor procedures.
The researchers also analyzed patients for major or minor complications. Major complications were those with systemic risks to the patient such as heart attack, stroke or pulmonary embolism. Minor complications were those that localized to the operative extremity.
Complications and risk factors
The overall complication rate for patients was 1.6%. Risk factors for a complication included black race, a previous operation within 30 days, operative time in excess of 1.5 hours and patients older than 40 years, according to Martin. The investigators found a minor morbidity rate of 0.86%, and deep vein thrombosis was the most common minor morbidity. Superficial surgical site infection, urinary tract infection and pneumonia were other common minor morbidities. The major morbidity rate was 0.76%, and the most common major morbidity was return to the operating room.
“We think most of those [that return to operating room] are related to wound issues, care of superficial wound infections or washouts of the joint,” Martin said. “Other major morbidities were deep surgical site infections, pulmonary embolism and sepsis.”
The lack of data on complications beyond 30 days and the combination of multiple procedures limited the study, according to Martin, but study strengths included its prospective, multicenter data collection.
“We think it would be reasonable to delay your elective knee arthroscopy if the patient has had another recent procedure, and we would encourage being efficient with operative time whenever possible,” Martin said. – by Renee Blisard Buddle
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Disclosure: Martin was a member of the grant review committee for the Musculoskeletal Transplant Foundation. He is on the AAOS publications committee and has grants from the OREF, OTA and IOS.
Perspective
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Jack M. Bert, MD
Knee arthroscopy is the most common procedure performed in the United States. In a recent published study that evaluated the candidate-reported complication rates from the American Board of Orthopedic Surgery, the overall reported complication rate was 4.7%. This data was obtained from 92,565 knee arthroscopic procedures submitted by board candidates. In this patient population, surgical complications were more common than medical complications and infection was the most common complication overall (0.84%).
In a higher powered study with a review of 180,717 knee arthroscopies published last year in the Arthroscopy, the most common adverse outcome was deep vein thrombosis (DVT). The 30-day readmission rate was 0.77%. Older age and presence of a comorbidity were significant factors in the development of complications S/P knee arthroscopy in this series.
In a meta-analysis review article in Arthroscopy in 2008, Bushnell and colleagues noted an incidence of DVT of 0% to 17.9% and concurred that it was the most common complication subsequent to arthroscopy of the knee. In a recent book chapter regarding infections S/P arthroscopy and related in an article in Arthroscopy in 2007, the incidence of infection was less than 0.2%. The authors’ (Martin and collegues) incidence of overall complications of 1.6% clearly points out that the incidence of arthroscopic complications is low, but definitely present, and should be discussed with each patient preoperatively. The authors furthermore emphasize that arthroscopic knee surgery is not a benign procedure and care should be taken to determine which patients should be anticoagulated and if patients have had recent surgery, perhaps they should be postponed to a later date to avoid higher complication rates.
References:
Bert JM. Sports Med Arthrosc. 2013;doi:10.1097/JSA.0b013e318290cb5b.
Bohensky R. Arthroscopy. 2013;doi:10.1016/j.arthro.2012.11.020.
Bushnell D. Arthroscopy. 2008;doi:10.1016/j.arthro.2007.11.010.
Salzler M. Am J Sports Med. 2014;doi:10.1177/0363546513510677.
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