Original Article
Adverse Outcomes Associated With Elective Knee Arthroscopy: A Population-Based Cohort Study

https://doi.org/10.1016/j.arthro.2012.11.020Get rights and content

Purpose

The aims of this study were to quantify the frequency of adverse outcomes after elective knee arthroscopies in Victoria, Australia, and to identify risk factors associated with adverse outcomes.

Methods

We performed a retrospective, longitudinal cohort study of elective orthopaedic admissions using the Victorian Admitted Episodes database, a routinely collected public and private hospital episodes database linked to death registry data, from July 1, 2000, to June 30, 2009. Adverse outcome measures included pulmonary embolism (PE), deep vein thrombosis (DVT), hemarthrosis, effusion and synovitis, cellulitis, wound infection, synovial fistula, acute renal failure, myocardial infarct, stroke, and death. Patients were excluded if they had an additional procedure performed during the arthroscopy admission. We identified complications during the admission and within readmissions up to 30 days after the procedure. PE, DVT, and death within 90 days of the arthroscopy episode were also examined. We used logistic regression analysis to identify risk factors associated with complications.

Results

After we excluded 16,807 patients (8.5%) with an additional procedure during their admission, there were 180,717 episodes involving an elective arthroscopy during the period studied. The most common adverse outcomes within 30 days were DVT (579, 0.32%), effusion and synovitis (154, 0.09%), PE (147, 0.08%), and hemarthrosis (134, 0.07%). The 30-day orthopaedic readmission rate was 0.77%, and there were 55 deaths (0.03%). Within 90 days of arthroscopy, we identified 655 events of DVT (0.36%) and 179 PE events (0.10%). Logistic regression analysis identified that potential risk factors for complications were older age, presence of comorbidity, being married, major mechanical issues, and having the procedure performed in a public hospital.

Conclusions

Our study found 6.4 adverse outcomes per 1,000 elective knee arthroscopy procedures (0.64%), with the 3 most common complications being DVT, effusion and synovitis, and PE. We have also identified risk factors for adverse outcomes, particularly chronic kidney disease, myocardial infarction, cerebrovascular accident, and cancer.

Level of Evidence

Level III, retrospective cohort study.

Section snippets

Methods

This study was a retrospective, population-based analysis of hospital administrative data, linked to provide longitudinal information about readmissions and death. We selected all patients with an admission containing a procedure code indicating an elective knee arthroscopy (Table 1) from July 1, 2000, to June 30, 2009. We included all endoscopic knee procedures with a therapeutic intervention, including ligament reconstruction. Patients were excluded if they had an additional procedure

Cohort Characteristics

After excluding 16,807 patients (8.5%) with an additional procedure during their admission, we identified 180,717 episodes involving an elective knee arthroscopy for 150,490 patients. The majority of procedures were same-day procedures (79.3%) performed in private hospitals (73.6%) in patients aged 40 to 59 years (45.1%). Public hospitals were less likely to have high elective orthopaedic volume compared with private hospitals (17.4% compared with 23.7%, P < .01). A concomitant definition of OA

Discussion

We quantified the frequency of adverse outcomes after elective knee arthroscopies in Victoria, Australia, and identified associated risk factors in a population-based cohort of 180,717 elective arthroscopies across a 9-year period. We found that 6.4 adverse events within 30 days are experienced per thousand arthroscopic procedures. The majority of the adverse event burden within 30 days is explained by VTE (4.0 per 1,000 procedures), which was associated with 12 deaths within 30 days (21.8% of

Conclusions

Our study found 6.4 adverse outcomes per 1,000 elective knee arthroscopy procedures (0.64%), with the 3 most common complications being DVT, effusion and synovitis, and PE. We have also identified risk factors for adverse outcomes, particularly chronic kidney disease, myocardial infarction, cerebrovascular accident, and cancer.

. Summary of Additional Variables

VariableDefinition
OA of kneeICD-10-AM codes M17.0-M17.9 throughout any diagnosis code
Year of arthroscopyFinancial year (July 1 to June 30)

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  • Cited by (0)

    The authors report the following potential source of funding in relation to this article: Arthritis Australia. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of this manuscript.

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