A few procedures account for most adverse events after orthopedic surgery

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Ten procedures generate the greatest number of adverse events in the first 30 days after orthopedic surgery, according to University of Michigan researchers.

Improving surgical quality has garnered increasing attention recently, according to Peter L. Schilling, MD, MSc, and colleagues at the University of Michigan. Achieving surgical quality improvements in orthopedic surgery, with its broad array of procedures across a wide range of human anatomy, is a particular challenge. It is unclear where orthopedic surgeons should focus their efforts to achieve the greatest improvement.

Using data from the American College of Surgeons National Surgical Quality Improvement Program, Schilling and colleagues identified all patients who underwent orthopedic surgery between 2005 and 2007. They assigned the 7,970 patients to 44 procedure groups based on the Current Procedural Terminology codes.

First, the researchers evaluated how each procedure group contributed to the overall number of adverse events in the first 30 postoperative days. Then, they described how those procedures related to an excess length of hospital stay.

The researchers found that 10 procedures were linked to 70% of the adverse events and 65% of the excess hospital days. Hip fracture repair accounted for the most adverse events (19%) followed by total knee arthroplasty (18%), total hip arthroplasty (11%), revision THA (5%), knee arthroscopy (5%), laminectomy (4%), lumbar/thoracic arthrodesis (2%), femoral fracture repair (2%), revision knee arthroplasty (2%), and ankle fracture repair (2%).

“Concentrating quality-improvement efforts on these procedures may be an effective way for surgeons and other stakeholders to improve perioperative care and reduce costs in orthopedic surgery,” the authors wrote.

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