Original ArticleRisk factors for prolonged operative time in femoral neck fracture patients undergoing hemiarthroplasty through direct anterior approach
Introduction
The direct anterior approach (DAA) is an inter-muscular approach that allows for the early recovery of mobility in patients undergoing total hip arthroplasty (THA) [1], [2]. Recently, this approach has also been used for femoral neck fractures in patients undergoing hemiarthroplasty, which has been shown to be associated with the early recovery of mobility [3], [4], [5]. Several studies have referred to the learning curve underlying DAA, recommending that surgeons should perform their initial DAA surgeries in thin patients [6], [7], [8], [9], which suggests that the operative time of the DAA may be longer for inexperienced surgeons and in obese or muscular patients. Prolonged operative time can lead to higher risks of developing surgical complications, such as deep-vein thrombosis and surgical site infections [10], [11], [12]. This scenario also entails an important economical aspect because managing these complications would require additional medical resources and prolonged operative time would also incur additional cost [13]. Furthermore, prolonged operative time would disrupt the schedule of an operating room, resulting in the overutilization of surgical resources [14]. Despite the importance of accurately predicting operative time, no studies have reported any risk factors for prolonged operative time in DAA hemiarthroplasty. Thus, the purpose of this study was to elucidate risk factors of prolonged operative time in DAA hemiarthroplasty.
Section snippets
Patients
This study was approved by the institutional ethics committee, and written informed consent was obtained from each patient for the publication of data. Prospectively collected data from 165 patients, who suffered femoral neck fracture patients and underwent hemiarthroplasty at a single institution (Kanagawa, Japan) between April 2014 and September 2017, were retrospectively evaluated. Hemiarthroplasty was recommended according to the Garden classification, age and pre-fracture mobility of the
Results
Of the 165 patients with femoral neck fractures, 14 patients who were treated using the direct lateral approach were excluded. These cases mostly dated to the early period of the study when several surgeons were still not confident in performing DAA, and data from the remaining 151 patients were included in this study. Mean age at admission was 83.8 [±6.3 standard deviation (SD)] years, and 41 patients (27%) were males. Mean operative time was 93.1 (±21 SD) min. None of the patients had
Discussion
This study identified approach depth and surgeons’ experience with DAA as predictors of the operative time of DAA hemiarthroplasty. The adjusted R2 value of the model (0.57) implies that the model can explain 57% of the variation in operative time variation. Importantly, because the mean age (77–86 years) and proportion of males (18%–24%) in our study are similar to those reported by several previous studies [3], [4], [5], our cohort is representative of patients with femoral neck fracture and
Conclusions
This study aimed toward determining the predictive factors for operative time in femoral neck fracture patients undergoing hemiarthroplasty through DAA. Our findings identified approach depth and surgeons’ DAA experience (<20 cases) as novel risk factors for prolonged operative time in hemiarthroplasty through DAA. Surgeons should consider these factors when estimating the operative time of surgery and selecting the most appropriate and safe surgical approach for a patient. Further, the
Conflict of interest
One author, Yutaka lnaba was invited as a speaker (not related to this study) at Stryker, Zimmer Biomet, Japan Medical Dynamic Marketing (MDM), and Smith & Nephew. Other authors declare no conflicts of interest.
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