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

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

doi:10.1007/s00590-024-03973-z

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

Eur J Orthop Surg Traumatol. 2024 May 15. doi: 10.1007/s00590-024-03973-z. Online ahead of print.

Authors

Jack Zhong^{1

2}, Nathan J Lee³, Connor Crutchfield³, John Mueller³, Christopher Ahmad³, David Trofa³, T S Lynch^{3

4}

Affiliations

¹ Department of Orthopedic Surgery, Columbia University, Address: 301 East 17th Street, 14th floor, New York, NY, 10003, USA. Jackrzhong@gmail.com.
² Department of Orthopedic Surgery, New York University Langone Health, New York, NY, 10016, USA. Jackrzhong@gmail.com.
³ Department of Orthopedic Surgery, Columbia University, Address: 301 East 17th Street, 14th floor, New York, NY, 10003, USA.
⁴ Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, USA.

PMID: 38748272
DOI: 10.1007/s00590-024-03973-z

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.

Keywords: 30-day complications; ACL reconstruction (ACLR); Anterior cruciate ligament (ACL); Arthroscopy; National surgical quality improvement project (NSQIP).