Risk Factors for Hospital Admission Following Arthroscopic Bankart Repair

Background:Nearly 350,000 Americans develop a deep venous thromboembolism (DVT) or pulmonary embolism (PE) annually, and nearly 100,000 Americans die from these events. To date, little research has investigated patient-specific risk factors that increase the rate of DVT/PE following anterior cruciate ligament reconstruction (ACLR).Purpose:To determine relevant patient risk factors for the development of DVT/PE following ACLR.Study Design:Case-control study; Level of evidence, 3.Methods:All instances of ACLR from 2005 to 2014 within the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) prospective database were analyzed. Both univariate analysis and binary logistic regression were performed to determine which patient demographics and surgical factors were associated with DVT or PE following surgery.Results:Of the 9146 patients who underwent ACLR, 46 (0.5%) developed postoperative DVT, 8 (0.1%) developed PE, and 5 (0.05%) developed both. The following variables were associated with the development of DVT or PE on univariate analysis: increased age, a high tibial osteotomy (HTO) performed at the time of ACLR, microfracture performed, the presence of hypertension requiring medical therapy, and the presence of an active wound infection. Independent predictors of DVT or PE on multivariate analysis included HTO (odds ratio [OR], 22.7), the presence of an active wound infection (OR, 11.0), or hypertension requiring medication (OR, 2.2). Meniscal repair was not a risk factor for DVT or PE on univariate or multivariate analysis.Conclusion:In a review of 9146 patients undergoing ACLR, 46 (0.5%) developed DVT in the 30-day postoperative period. Increasing age over 30 years, concomitant HTO or microfracture, hypertension requiring medication, and presence of wound infection were all associated with an increased risk of DVT. The annual incidence of DVT/PE following ACLR reconstruction is low (<1%) and has not changed over time.

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“…The literature has shown the NSQIP to be a high-quality database to study perioperative complications. 2 , 6 , 7 , 12 , 13 , 20 , 21 , 24 , 26 …”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Deep Vein Thrombosis or Pulmonary Embolus Following Anterior Cruciate Ligament Reconstruction

Bokshan

DeFroda

Panarello

et al. 2018

Orthopaedic Journal of Sports Medicine

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“…Additionally, longer operative times have been found to be a risk factor for postoperative hospital admission, which itself was the largest cost driver in the arthroscopic Bankart and Latarjet groups. 6 The use of regional anesthesia over general anesthesia was also found to increase costs in the arthroscopic Bankart and Latarjet groups in the univariate analysis. It was also a cost driver for arthroscopic Bankart repair in multivariate regression.…”

Section: Discussionmentioning

confidence: 92%

Cost Drivers Associated With Anterior Shoulder Stabilization Surgery

Bokshan

Levins

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Arthroscopic Bankart repair, open Bankart repair, and the Latarjet procedure are common treatments for anterior shoulder instability; however, little is known of costs by patient- and surgeon-specific factors. This study aimed to identify areas where cost reduction may be achieved. Hypothesis: Increased total charges will be associated with low-volume surgeons and surgical facilities, hospital-owned facilities, open surgical techniques, and patients with at least 1 comorbidity. Study Design: Economic and decision analysis; Level of evidence, 3. Methods: The 2014 State Ambulatory Surgery and Services Databases from 6 states were utilized. There were 3 Current Procedural Terminology codes (23455, 23462, 29806) used to identify open Bankart repair, the Latarjet procedure, and arthroscopic Bankart repair, respectively. Patient demographic and surgical variables were evaluated on a univariate basis, and all significant factors were then included in the multiple linear regression to determine which factors had the largest effect on cost. Total charges billed for the encounter were used as a proxy for cost of surgery. Results: For open Bankart repair, arthroscopic Bankart repair, and the Latarjet procedure, longer operative times increased costs, and high-volume surgical facilities had decreased charges. For the arthroscopic Bankart group, additional factors that increased charges included postoperative hospital admission (US$11,516; P < .001), patient residence in a ZIP code with a below-median income (US$2909; P < .001), presence of a comorbidity (US$1982; P < .001), male sex (US$1545; P = .003), Hispanic race (US$2493; P = .005), and use of regional anesthesia (US$1898; P = .025). Additional cost drivers for the Latarjet procedure included postoperative hospital admission (US$7028; P = .022) and older age (US$187/y; P = .039). Conclusion: Postoperative admission to the hospital was the largest cost driver for arthroscopic Bankart repair and the Latarjet procedure. Low-volume facilities were the largest cost driver for open Bankart repair. High-volume surgery centers had lower costs when compared with low-volume surgery centers. Regional anesthesia increased costs in the arthroscopic Bankart group. These findings may help to show where cost savings can be achieved, particularly considering increasing trends toward bundled health care payments.

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“…Beletsky et al 23 evaluated the likelihood of patients to achieve a Patient-Acceptable Symptomatic State (PASS) after ACLR. They found that DM reduced the likelihood of achieving PASS on the activities of daily living section of the Knee Injury and Osteoarthritis Outcome Score (KOOS ADL), indicating that patients with DM were more bothered by symptoms noticed during their ADLs.…”

Section: Patient-reported and Functional Outcomesmentioning

confidence: 99%

“…Within a cohort of 63 patients who underwent labral repairs for type 2 SLAP lesions, Frank et al 22 found that patients with DM were less likely to achieve a postoperative American Society of Shoulder and Elbow Surgery (ASES) score of greater than 50, indicating an overall worse shoulder function. Beletsky et al 23 evaluated the likelihood of patients to achieve a Patient-Acceptable Symptomatic State (PASS) after ACLR. They found that DM reduced the likelihood of achieving PASS on the activities of daily living section of the Knee Injury and Osteoarthritis Outcome Score (KOOS ADL), indicating that patients with DM were more bothered by symptoms noticed during their ADLs.…”

Section: Patient-reported and Functional Outcomesmentioning

confidence: 99%

Diabetes in Orthopaedic Sports Medicine Surgeries Standard Review

Morriss,

Brophy

2023

J Am Acad Orthop Surg

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Diabetes mellitus has been shown to affect the outcomes of various orthopaedic procedures. Although orthopaedic sports medicine procedures tend to be less invasive and are often performed on younger and healthier patients, diabetes is associated with an increased risk of postoperative infection, readmission, and lower functional outcome scores. However, this risk may be moderated by the glycemic control of the individual patient, and patients with a low perioperative hemoglobin A1c may not confer additional risk. Further research is needed to evaluate the impact of diabetes on surgical outcomes in sports orthopaedics is needed, with the goal of evaluating mediating factors such as glycemic control in mind.

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Risk Factors for Hospital Admission Following Arthroscopic Bankart Repair

Cited by 5 publications

References 31 publications

Risk Factors for Deep Vein Thrombosis or Pulmonary Embolus Following Anterior Cruciate Ligament Reconstruction

Risk Factors for Deep Vein Thrombosis or Pulmonary Embolus Following Anterior Cruciate Ligament Reconstruction

Cost Drivers Associated With Anterior Shoulder Stabilization Surgery

Diabetes in Orthopaedic Sports Medicine Surgeries Standard Review

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