title: Morbid Obesity and Congestive Heart Failure Increase Operative Time and Room Time in Total Hip Arthroplasty.
abstract: BACKGROUND
  Obesity is increasingly common in patients having total hip arthroplasty, and previous studies have shown a correlation with increased operative time in total hip arthroplasty. Decreasing operative time and room time is essential to meeting the increased demand for total hip arthroplasty, and factors that influence these metrics should be quantified to allow for targeted reduction in time and adjusted reimbursement models. This is the first study to use a multivariate approach to identify which factors increase operative time and room time in total hip arthroplasty.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program database was used to identify a cohort of 30,361 patients having total hip arthroplasty between 2006 and 2012. Patient demographics, comorbidities including body mass index, and anesthesia type were used to create generalized linear models identifying independent predictors of increased operative time and room time.
  
  
  RESULTS
  Morbid obesity (body mass index >40) independently increased operative time by 13 minutes and room time 18 by minutes. Congestive heart failure led to the greatest increase in overall room time, resulting in a 20-minute increase. Anesthesia method further influenced room time, with general anesthesia resulting in an increased room time of 18 minutes compared with spinal or regional anesthesia.
  
  
  CONCLUSIONS
  Obesity is the major driver of increased operative time in total hip arthroplasty. Congestive heart failure, general anesthesia, and morbid obesity each lead to substantial increases in overall room time, with congestive heart failure leading to the greatest increase in overall room time.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: J Joseph
authors.initials: JJ
authors.lastname: Gholson
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Apurva S
authors.initials: AS
authors.lastname: Shah
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Yubo
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Nicolas O
authors.initials: NO
authors.lastname: Noiseux
mesh_terms: D000768:Anesthesia, General / Q000706:statistics & numerical data; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D006333:Heart Failure; D006801:Humans; D016014:Linear Models; D008297:Male; D009767:Obesity, Morbid; D061646:Operative Time; D012189:Retrospective Studies
keywords: anesthesia type; congestive heart failure; obesity; operative time; room time; total hip arthroplasty