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Impact of surgical case order on peri-operative outcomes for total joint arthroplasty

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Abstract

Introduction

There is growing support in the literatures that peri-operative outcomes are adversely affected by surgical case order in some certain surgical procedures. This study aimed to examine if similar phenomenon is also shared in total joint arthroplasty (TJA).

Methods

A total of 6548 joints (5183 patients) treated with primary TJA by a total of five surgeons at our institution from December 2011 to December 2015 were retrospectively reviewed in this study. Demographic data, operative duration, blood loss, peri-operative adverse events, medical cost, and length of hospital stay were collected and analyzed. Logistic regression was used to determine risk factors for adverse events.

Results

Of the 6548 cases in this cohort, 1643 TJAs were classified as first round cases, 1744 TJAs were second round cases, 1600 TJAs were third round cases, and 1561 TJAs were fourth or later round cases. Mean operating time was shorter in the intermediate cases (45.0 vs. 41.0 vs. 41.8 vs. 54.1 min, P < 0.01). Peri-operative arthroplastic adverse events were increased in later surgical cases (2.07% vs. 2.18% vs. 3.06% vs. 4.87%, P < 0.01). Later case order (OR = 1.40 [95% CI: 1.22–1.61], P < 0.01) was a significant risk factor of arthroplastic adverse events. Patients undergoing TJA later in the day were more likely to have longer length of stay and higher cost than earlier cases. Peri-operative systemic complications and blood loss did not significantly differ between groups.

Conclusion

Surgical case order is an independent risk factor for arthroplastic adverse events in TJA. TJA procedures performed later in the day have a higher risk for arthroplastic adverse events, but not for systematic adverse events. Significantly increased operative time, higher cost, and longer LOS were noted for fourth or later TJA cases. Data in our study reveals that performing more than three TJAs within a single day may imply compromised outcomes.

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Acknowledgements

We thank the patients who enrolled in this study and the staff involved in this work.

Funding

This study was funded by Beijing Natural Science Foundation (7174384).

Author information

Authors and Affiliations

  1. Department of Orthopedics, Chinese PLA General Hospital and Medical School of Chinese PLA, Beijing, 100853, China

    Li Xiang, Dong Jiyuan, Zhang Guoqiang, Chai Wei & Chen Jiying

  2. Department of Orthopedics, Beijing Jishuitan Hospital and Peking University Fourth School of Clinical Medicine, Beijing, 100853, China

    Zhang Qi

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  1. Li Xiang
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  3. Dong Jiyuan
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Correspondence to Chen Jiying.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Li Xiang and Zhang Qi contribute equally to this work.

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Cite this article

Li, X., Zhang, Q., Dong, J. et al. Impact of surgical case order on peri-operative outcomes for total joint arthroplasty. International Orthopaedics (SICOT) 42, 2289–2294 (2018). https://doi.org/10.1007/s00264-018-3835-9

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  • DOI: https://doi.org/10.1007/s00264-018-3835-9

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