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Characteristics of early complications in isolated primary anterior cruciate ligament reconstruction surgery

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The early complications of isolated anterior cruciate ligament reconstruction surgery (ACLR) have not been well characterized using large databases. This study aims to characterize incidence, impact, and risk factors for short-term operative complications following elective, isolated ACLR surgery. We hypothesize that demographic and perioperative factors may predict 30-day complications after isolated ACLR.

Methods

This case–control analysis of the American College of Surgeons National Surgical Quality Improvement Program Database (2005–2017) used Current Procedural Terminology codes to identify elective, isolated ACLR patients. Patients undergoing concomitant procedures were excluded. Complications were analyzed using bivariate analysis against demographic variables. Multiple stepwise logistic regression was used to identify independent risk factors for morbidity after ACLR.

Results

A total 12,790 patients (37.0% female, p = 0.674) were included with a mean age of 32.2 years old (SD 10.7 years, p < 0.001). Mean BMI was 27.8 kg/m2 (6.5) where 28.9% of patients had a BMI > 30 (p = 0.064). The most common complications were wound-related (0.57%). In cases with complications, there were higher rates of (1.3% vs 0.8%, p = 0.004) prolonged operation (> 1.5 h), higher rate (2.9% vs 1.8%, p = 0.004) of extended length of stay (≥ 1 day), unplanned reoperation (15.8% vs 0.3%, p < 0.001), and unplanned readmission (17.5% vs 0.3%, p < 0.001). Multivariate analysis showed prolonged operative time (p = 0.001), dyspnea (p = 0.008), and non-ambulatory surgery (p = 0.034) to be predictive of any complication. Dependent functional status (p = 0.091), mFI-5 > 0.2 (= 0.173), female sex (p = 0.191), obesity (p = 0.101), and smoking (p = 0.113) were not risk factors for complications.

Conclusion

ACLR is associated with low rates of morbidity and readmissions. The most common comorbidities, complications, and predictors of morbidities were identified to aid surgeons in further reducing adverse outcomes of ACLR. Operative time > 1.5 h, dyspnea, and non-ambulatory surgery are predictive of complications.

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Availability of data and materials

The datasets generated and/or analyzed during the current study are available in the American College of Surgeons National Surgical Quality Improvement Program repository, which can be found and requested at: https://www.facs.org/quality-programs/data-and-registries/acs-nsqip/

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Acknowledgements

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Funding

No funding was received for any part of this study.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Columbia University, Address: 301 East 17th Street, 14th floor, New York, NY, 10003, USA

    Jack Zhong, Nathan J. Lee, Connor Crutchfield, John Mueller, Christopher Ahmad, David Trofa & T. S. Lynch

  2. Department of Orthopedic Surgery, New York University Langone Health, New York, NY, 10016, USA

    Jack Zhong

  3. Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, USA

    T. S. Lynch

Authors
  1. Jack Zhong
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  2. Nathan J. Lee
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  3. Connor Crutchfield
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  4. John Mueller
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  5. Christopher Ahmad
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  6. David Trofa
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  7. T. S. Lynch
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Contributions

JZ contributed to research idea, analyzed patient data, and drafted the first version of the manuscript. NJ, CC, JM, CA, DT, and TSL contributed to initial research idea and made meaningful contributions to subsequent versions of the manuscript and the final version.

Corresponding author

Correspondence to Jack Zhong.

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Conflict of interest

CA receives IP royalties, is a Paid consultant, and conducts Research support from Arthrex, Inc; he owns stock or options for Peak; he receives publishing royalties, financial, or material support from Lead Player; he conducts research support for Major League Baseball; he is on the editorial or governing board for Orthopedics Today; he conducts research support for Stryker. TSL is a Board or Committee Member of American Orthopaedic Society for Sports Medicine; he is a paid consultant for CONMED Linvatec and Smith and Nephew. The remaining authors have no competing interests to disclose.

Ethics approval

The project described involved no identifiable patient data, direct patient contact, minimal risk to patients, and was declared to the institutional review board at the affiliated institution1 to be exempt from further IRB approval under protocol #AAAS5527. Further documentation can be provided upon request.

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Not applicable. No individual person’s data are included.

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Zhong, J., Lee, N.J., Crutchfield, C. et al. Characteristics of early complications in isolated primary anterior cruciate ligament reconstruction surgery. Eur J Orthop Surg Traumatol (2024). https://doi.org/10.1007/s00590-024-03973-z

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