title: Operative Time Affects Short-Term Complications in Total Joint Arthroplasty.
abstract: Increased operative time has been associated with increased complications after total joint arthroplasty (TJA). The purpose of the present study was to investigate the effect of operative time on short-term complications after TJA while also identifying patient and operative factors associated with prolonged operative times.
  
  
  
  The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2011-2013 to identify all patients who underwent primary total hip or knee arthroplasty. Patients were stratified by operative time, and 30-day morbidity and mortality data compared using univariate and multivariable analyses.
  
  
  
  We identified 99,444 patients who underwent primary TJA. The overall incidence of complications after TJA was 4.9%. Overall complications were increased in patients with operative times >120 minutes (5.9%) as compared to patients with operative times <60 minutes or 60-120 minutes (4.6% and 4.8%, respectively; P < .001). Wound complications, including surgical site infection, were also increased for procedures lasting >120 minutes. In a multivariable analysis, operative time exceeding 120 minutes remained an independent predictor of any complication and wound complication, with each 30-minute increase in operative time beyond 120 minutes further increasing risk. Patient age ≤65 years, male sex, black race, body mass index ≥30 kg/m2, and an American Society of Anesthesiologists classification of 3 or 4, predicted operative times >120 minutes.
  
  
  
  We found that operative time >120 minutes was associated with increased short-term morbidity and mortality after primary TJA. Younger age, male sex, black race, obesity, and increased comorbidity were risk factors for operative time exceeding 120 minutes.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Kyle R
authors.initials: KR
authors.lastname: Duchman
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Pugely
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Martin
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: Nicholas A
authors.initials: NA
authors.lastname: Bedard
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: John J
authors.initials: JJ
authors.lastname: Callaghan
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009765:Obesity / Q000150:complications; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology; D014481:United States / Q000453:epidemiology
keywords: complications; operative time; total hip arthroplasty; total joint arthroplasty; total knee arthroplasty; wound complications