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Unplanned return to the operating room after arthroscopic procedures: a need to consider 12 months after the initial surgery

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The purpose of this study was to report the proportion and cause of unplanned revision surgery rates within 1 year following arthroscopic procedures. Our hypothesis was that there is a significant rate of unplanned returns (URs) occurring between 3 and 12 months after the initial procedure and that causes of revision are different when considering the delay after the index surgery.

Materials and methods

Among 4142 consecutive patients who underwent an arthroscopic procedure in a single department of orthopedics and traumatology, patients undergoing revision surgery for any reasons directly related to the primary procedure were included. Cause for revision, surgical site, delay from index procedure, and number of revisions were screened.

Results

Seventy-eight patients underwent 97 revision surgeries (2.3%) for reasons directly related to the primary procedure. Most revision surgeries were performed after month 3 following index surgery (59 patients, 60.8%). Mean time to revision surgery was 5.3 ± 4.3 months (range 0–365 days). Usual early-onset (< 3 months) reasons for unplanned revision were surgical site infection (17 patients, 0.41%), wound-healing defect (12 patients, 0.29%), and hemorrhagic complication (7 patients, 0.17%). Reasons for delayed unplanned revision (> 3 months) were index procedure failure (21 patients, 0.51%), stiffness (18 patients, 0.43%), and removal of hardware (16 patients, 0.41%).

Conclusions

Reasons for return to the operating room (OR) are different depending on the timepoint from index procedure. Patients should receive relevant information accordingly when scheduling any arthroscopic procedure, including up to 1-year potential complications.

Level of evidence

Prognostic study, Case series, Level IV.

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Availability of data and materials

Available in the data system of the hospital.

References

  1. Accreditation Council for Graduate Medical Education (ACGME). Data resource book. 2020 Report

  2. Gil JA, Waryasz GR, Owens BD, Daniels AH (2016) Variability of arthroscopy case volume in orthopaedic surgery residency. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 32:892–897. https://doi.org/10.1016/j.arthro.2016.01.018

    Article  Google Scholar 

  3. Gordon AM, Flanigan DC, Malik AT, Vasileff W (2020) Orthopaedic surgery sports medicine fellows see substantial increase in hip arthroscopy procedural volume with high variability from 2011–2016. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. https://doi.org/10.1016/j.arthro.2020.09.043

    Article  Google Scholar 

  4. Maradit Kremers H, Schilz SR, Van Houten HK et al (2017) Trends in utilization and outcomes of hip arthroscopy in the United States Between 2005 and 2013. J Arthroplasty 32:750–755. https://doi.org/10.1016/j.arth.2016.09.004

    Article  PubMed  Google Scholar 

  5. Degen RM, Lebedeva Y, Birmingham TB et al (2020) Trends in knee arthroscopy utilization: a gap in knowledge translation. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 28:439–447. https://doi.org/10.1007/s00167-019-05638-5

    Article  Google Scholar 

  6. Bonazza NA, Liu G, Leslie DL, Dhawan A (2017) Trends in surgical management of shoulder instability. Orthop J Sports Med 5:2325967117712476. https://doi.org/10.1177/2325967117712476

    Article  PubMed  PubMed Central  Google Scholar 

  7. Yian EH, Weathers M, Knott JR et al (2020) Predicting failure after primary arthroscopic bankart repair: analysis of a statistical model using anatomic risk factors. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 36:964–970. https://doi.org/10.1016/j.arthro.2019.11.109

    Article  Google Scholar 

  8. Intravia J, Acevedo DC, Chung W-LJ, Mirzayan R (2020) Complications of elbow arthroscopy in a community-based practice. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 36:1283–1290. https://doi.org/10.1016/j.arthro.2019.11.108

    Article  Google Scholar 

  9. Gowd AK, Liu JN, Bohl DD et al (2019) Operative time as an independent and modifiable risk factor for short-term complications after knee arthroscopy. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 35:2089–2098. https://doi.org/10.1016/j.arthro.2019.01.059

    Article  Google Scholar 

  10. Nicolay RW, Selley RS, Terry MA, Tjong VK (2019) Body mass index as a risk factor for 30-day postoperative complications in knee, hip, and shoulder arthroscopy. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 35:874-882.e3. https://doi.org/10.1016/j.arthro.2018.10.108

    Article  Google Scholar 

  11. Westermann RW, Pugely AJ, Ries Z et al (2015) Causes and predictors of 30-day readmission after shoulder and knee arthroscopy: an analysis of 15,167 cases. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 31:1035-1040.e1. https://doi.org/10.1016/j.arthro.2015.03.029

    Article  Google Scholar 

  12. Pujol N, Merrer J, Lemaire B et al (2015) Unplanned return to theater: a quality of care and risk management index? Orthop Traumatol Surg Res OTSR 101:399–403. https://doi.org/10.1016/j.otsr.2015.03.013

    Article  CAS  PubMed  Google Scholar 

  13. Du JY, Knapik DM, Trivedi NN et al (2019) Unplanned admissions following hip arthroscopy: incidence and risk factors. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 35:3271–3277. https://doi.org/10.1016/j.arthro.2019.06.021

    Article  Google Scholar 

  14. Hartwell MJ, Morgan AM, Johnson DJ et al (2019) Risk factors for 30-day readmission following knee arthroscopy. J Knee Surg. https://doi.org/10.1055/s-0039-1692631

    Article  PubMed  Google Scholar 

  15. Hill JR, McKnight B, Pannell WC et al (2017) Risk factors for 30-day readmission following shoulder arthroscopy. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 33:55–61. https://doi.org/10.1016/j.arthro.2016.06.048

    Article  Google Scholar 

  16. Novi M, Vanni C, Parchi PD et al (2020) Claims in total hip arthroplasty: analysis of the instigating factors, costs and possible solution. Musculoskelet Surg 104:43–48. https://doi.org/10.1007/s12306-019-00590-6

    Article  CAS  PubMed  Google Scholar 

  17. Light A, Gupta T, Nandakumar M et al (2019) Pre-designed consent forms for total hip replacement, total knee replacement, and caesarean section: a national observational study of current English practice. Surg J R Coll Surg Edinb Irel 17:193–200. https://doi.org/10.1016/j.surge.2018.06.001

    Article  Google Scholar 

  18. Healy WL, Iorio R, Clair AJ et al (2016) Complications of total hip arthroplasty: standardized list, definitions, and stratification developed by the hip society. Clin Orthop 474:357–364. https://doi.org/10.1007/s11999-015-4341-7

    Article  PubMed  Google Scholar 

  19. Clement ND, Bardgett M, Weir D et al (2018) Three groups of dissatisfied patients exist after total knee arthroplasty: early, persistent, and late. Bone Jt J 100-B:161–169. https://doi.org/10.1302/0301-620X.100B2.BJJ-2017-1016.R1

    Article  CAS  Google Scholar 

  20. Gunaratne R, Pratt DN, Banda J et al (2017) Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 32:3854–3860. https://doi.org/10.1016/j.arth.2017.07.021

    Article  PubMed  Google Scholar 

  21. Kopf S, Beaufils P, Hirschmann MT et al (2020) Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 28:1177–1194. https://doi.org/10.1007/s00167-020-05847-3

    Article  Google Scholar 

  22. Pujol N, Beaufils P (2019) Save the meniscus again! Knee Surg Sports Traumatol Arthrosc Off J ESSKA 27:341–342. https://doi.org/10.1007/s00167-018-5325-4

    Article  Google Scholar 

  23. Schweizer C, Hanreich C, Tscholl PM et al (2021) Nineteen percent of meniscus repairs are being revised and failures frequently occur after the second postoperative year: a systematic review and meta-analysis with a minimum follow-up of 5 years. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. https://doi.org/10.1007/s00167-021-06770-x

    Article  Google Scholar 

  24. Tardy N, Boisrenoult P, Teissier P et al (2017) Clinical outcomes after multiligament injured knees: medial versus lateral reconstructions. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 25:524–531. https://doi.org/10.1007/s00167-016-4067-4

    Article  CAS  Google Scholar 

  25. Heitmann M, Akoto R, Krause M et al (2019) Management of acute knee dislocations: anatomic repair and ligament bracing as a new treatment option-results of a multicentre study. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 27:2710–2718. https://doi.org/10.1007/s00167-018-5317-4

    Article  CAS  Google Scholar 

  26. Hanley J, Westermann R, Cook S et al (2017) Factors associated with knee stiffness following surgical management of multiligament knee injuries. J Knee Surg 30:549–554. https://doi.org/10.1055/s-0036-1593624

    Article  PubMed  Google Scholar 

  27. Billières J, Labruyère C, Steltzlen C et al (2019) Multiligament knee injuries treated by one-stage reconstruction using allograft: postoperative laxity assessment using stress radiography and clinical outcomes. Orthop Traumatol Surg Res OTSR. https://doi.org/10.1016/j.otsr.2019.08.001

    Article  PubMed  Google Scholar 

  28. Ranger P, Renaud A, Phan P et al (2011) Evaluation of reconstructive surgery using artificial ligaments in 71 acute knee dislocations. Int Orthop 35:1477–1482. https://doi.org/10.1007/s00264-010-1154-x

    Article  PubMed  Google Scholar 

  29. Ibrahim SAR, Ghafar S, Salah M et al (2013) Surgical management of traumatic knee dislocation with posterolateral corner injury. Arthrosc J Arthrosc Relat Surg 29:733–741. https://doi.org/10.1016/j.arthro.2012.11.021

    Article  Google Scholar 

  30. Balato G, Di Donato SL, Ascione T et al (2017) Knee septic arthritis after arthroscopy: incidence, risk factors, functional outcome, and infection eradication rate. Joints 5:107–113. https://doi.org/10.1055/s-0037-1603901

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Gathen M, Makridis KG, Giannoudis PV (2018) Profile of litigation for orthopaedic trauma. Injury 49:1001–1002. https://doi.org/10.1016/j.injury.2018.05.014

    Article  CAS  PubMed  Google Scholar 

  32. Jena AB, Seabury S, Lakdawalla D, Chandra A (2011) Malpractice risk according to physician specialty. N Engl J Med 365:629–636. https://doi.org/10.1056/NEJMsa1012370

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Shah KN, Eltorai AEM, Perera S et al (2018) Medical malpractice litigation following arthroscopic surgery. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 34:2236–2244. https://doi.org/10.1016/j.arthro.2018.02.035

    Article  Google Scholar 

  34. Gruneir A, Dhalla IA, van Walraven C et al (2011) Unplanned readmissions after hospital discharge among patients identified as being at high risk for readmission using a validated predictive algorithm. Open Med Peer-Rev Indep Open-Access J 5:e104-111

    Google Scholar 

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Acknowledgements

The authors are grateful to other members in the department for their contributions and suggestions. This study was performed at Centre Hospitalier de Versailles.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Centre Hospitalier de Versailles, Le Chesnay, France

    Victoria Teissier & Nicolas Pujol

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  1. Victoria Teissier
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Contributions

VT and NP reviewed the data files, designed the study and wrote the paper equally.

Corresponding author

Correspondence to Nicolas Pujol.

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The authors did not declare any conflict of interest related to this work.

Ethical approval and consent to participate

The study was registered in the National Committee of Computer Science and Liberties register (CNIL-No. 2223886 version 0); data review was conducted following the ethical standards of the 1964 Declaration of Helsinki and the Methodology of Reference MR-003. No participant declined to participate in this study.

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Teissier, V., Pujol, N. Unplanned return to the operating room after arthroscopic procedures: a need to consider 12 months after the initial surgery. Arch Orthop Trauma Surg 143, 2055–2062 (2023). https://doi.org/10.1007/s00402-022-04522-1

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  • DOI: https://doi.org/10.1007/s00402-022-04522-1

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