Procedure Duration, Time Under Anesthesia, and Readmissions in Direct Anterior and Posterior Approach Total Hip
Kent R Kraus1, Julian E Dilley1, Mary Ziemba-Davis2
1Medical Resident, Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Insights
Direct anterior approach (DA) total hip arthroplasty (THA) takes longer than posterior approach THA. While DA procedures had longer anesthesia times, neither approach showed differences in 90-day readmissions.
Area of Science:
- Orthopedic Surgery
- Surgical Outcomes Research
Background:
- Operative time is a known factor influencing complications in primary total hip arthroplasty (THA).
- This study investigates operative time differences between direct anterior (DA) and posterior approaches to THA.
- The research examines if these operative time variations correlate with 90-day hospital readmission rates.
Purpose of the Study:
- To compare operative times between direct anterior (DA) and posterior approaches in total hip arthroplasty (THA).
- To determine if differences in operative time between these THA approaches are associated with increased hospital readmissions within 90 days.
Main Methods:
- Retrospective review of prospectively documented data from 3,152 primary THAs performed by 16 experienced surgeons.
- Analysis included 1,235 DA approach cases and 1,608 posterior approach cases, excluding those with factors extending operative time.
- Patient demographics, American Society of Anesthesiologists Physical Status (ASA-PS) classification, and setting (hospital vs. ambulatory) were considered.
Main Results:
- Anesthesia time was significantly longer for DA procedures (19-27 minutes more than posterior approach).
- Increasing body mass index disproportionately impacted anesthesia time in DA patients.
- No significant difference in nontraumatic 90-day readmissions was found between DA and posterior approaches; however, higher ASA-PS patients undergoing DA THA had more readmissions.
Conclusions:
- Anesthesia time in THA is a modifiable risk factor impacting patient safety and healthcare resource utilization.
- Strategies to reduce operative times for the direct anterior approach (DA) in THA should be explored.
- While operative time differs, the direct anterior approach (DA) did not show increased readmissions compared to the posterior approach in this study.
Background:
Operative time is related to complications in primary total hip arthroplasty (THA). This study compared operative time in direct anterior (DA) and posterior approach THA and whether differences were related to increased hospital readmissions within 90 days of discharge.
Methods:
Prospectively documented data on 3,152 consecutively performed THAs by 16 surgeons at a large Midwestern United States academic healthcare system were retrospectively reviewed. All surgeons were beyond their learning curve. Cases characterized by factors extending operative time were excluded. A total of 1,235 analysis cases were performed with the DA approach and 1,608 with the posterior approach. DA patients had lower mean body mass index (P < .001), were more likely to be classified as American Society of Anesthesiologists Physical Status 1 or 2 (P < .001), and more likely to have surgery in an ambulatory setting (P < .001).
Results:
Time under anesthesia was significantly longer for DA procedures by 19 to 27 minutes in hospital and ambulatory settings, respectively (P < .001). Increasing body mass index had a greater impact on anesthesia time for DA patients (P = .020). There were no differences in nontraumatic readmissions within 90 days of surgery based on surgical approach (P ≥ .480); however, significantly more DA patients classified as ASA-PS 3 or 4 were readmitted compared to those classified as ASA-PS 1 or 2 (P < .001), a difference not observed for posterior approach patients.
Conclusion:
Anesthesia time is a modifiable risk factor for patient safety and an important factor in healthcare resource utilization. Consideration of ways to reduce DA operative times is encouraged.
