P009 - Predicting Complications and Extended Stay following Treatment of Chondral Lesions
Abstract
Purpose
PURPOSE: The literature on predictors of short-term complications following treatment of chondral lesions is ambiguous. The purpose is to identify predictors of short-term complications in patients undergoing surgery for the management of chondral lesions.
Methods and Materials
The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) were queried for primary procedures of chondroplasty (29877), microfracture (29879), arthroscopic osteochondral allograft transplantation (29867), arthroscopic osteochondral autograft transplantation (29866), open osteochondral allograft transplantation (27415), open osteochondral autograft transplantation (27416), and autologous chondrocyte implantation (27412) between 2005 and 2017. Cases were stratified by days from operation to discharge, with patients with greater than 1 day prior to discharge defined as extended stay. Predictors of outcomes was assessed by bivariate and multivariate linear regressions, in comparison with 18 other perioperative factors. Outcome measures included severe complications (readmission, reoperation, and mortality), minor complications (pneumonia, urinary tract infection, renal insufficiency, transfusion, superficial incisional infection, or wound disruption), infectious complications (superficial incisional infection, deep incisional infection, organ/space incisional infection, sepsis, septic shock, or wound disruption) within 30 days of surgery, as well as extended stay following surgery.
Results
A total of 11,788 cases were analyzed. On multivariate analysis, inpatient procedure, preoperative bleeding event requiring transfusion, dialysis patients, admission from non-home facility, and a history of disseminated cancer were independently associated with an increased risk of a severe complication (OR: 2.44-8.31, p<.001). Inpatient surgery was also a significant predictor of increased minor and infectious complications. Age >55, chronic steroid use, ASA classification, dependent functional status, diabetes, preoperative bleeding, dialysis, and notably, no closure of surgical incisions was predictive of longer period to discharge (OR: 1.29-4.25, p<0.001).
Conclusion
Based on these findings, careful consideration before inpatient surgery for the treatment of chondral lesions may prove valuable in surgical decision-making.
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