Few Complications Follow Elective Knee Arthroscopy

In a retrospective review of 12,271 patient records obtained from a national database, researchers from the University of Iowa discovered an overall complication rate of less than 2 percent and a major morbidity rate of less than 1 percent within 30 days following elective knee arthroscopy.

“Morbidity was low at 1.6 percent and the risk factors we identified were longer operative times, older patient age, patients who had other recent operations and black race,” said study author Christopher T. Martin, M.D.

Martin and colleagues used data from the American College of Surgeons National Surgical Quality Improvement Program, which contains prospectively collected information from 258 hospitals, to identify knee arthroscopy patients.

The researchers excluded acute trauma cases, patients with preoperative wound contamination and preoperative sepsis. Patients were stratified based on procedure type. “We considered a major procedure to be anything that required a reconstruction or additional incisions about the knee, such as ACL reconstructions or meniscal transplants,” Martin said. “[The] minor procedures were surgeries that did not need additional incisions or that did not require a reconstruction, such as synovectomies or loose body removals,” he said. There were approximately 2,000 major and 10,000 minor procedures.

The researchers also analyzed patients for major or minor complications. Major complications were those with systemic risks to the patient such as heart attack, stroke or pulmonary embolism. Minor complications were those that localized to the operative extremity.

The overall complication rate for patients was 1.6 percent. Risk factors for a complication included black race, a previous operation within 30 days, operative time in excess of 1.5 hours and patients older than 40 years, according to Martin. The investigators found a minor morbidity rate of 0.86 percent, and deep vein thrombosis was the most common minor morbidity. Superficial surgical site infection, urinary tract infection and pneumonia were other common minor morbidities. The major morbidity rate was 0.76 percent, and the most common major morbidity was return to the operating room.

“We think most of those [that return to operating room] are related to wound issues, care of superficial wound infections or washouts of the joint,” Martin said. “Other major morbidities were deep surgical site infections, pulmonary embolism and sepsis.”

The lack of data on complications beyond 30 days and the combination of multiple procedures limited the study, according to Martin, but study strengths included its prospective, multicenter data collection.

“We think it would be reasonable to delay your elective knee arthroscopy if the patient has had another recent procedure, and we would encourage being efficient with operative time whenever possible,” Martin said