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Abstract：
BACKGROUND: Obesity is increasingly common in patients having total hip arthroplasty, and previous studies have shown a correlation with increased operative time in total hip arthroplasty. Decreasing operative time and room time is essential to meeting the increased demand for total hip arthroplasty, and factors that influence these metrics should be quantified to allow for targeted reduction in time and adjusted reimbursement models. This is the first study to use a multivariate approach to identify which factors increase operative time and room time in total hip arthroplasty.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was used to identify a cohort of 30,361 patients having total hip arthroplasty between 2006 and 2012. Patient demographics, comorbidities including body mass index, and anesthesia type were used to create generalized linear models identifying independent predictors of increased operative time and room time.
RESULTS: Morbid obesity (body mass index >40) independently increased operative time by 13 minutes and room time 18 by minutes. Congestive heart failure led to the greatest increase in overall room time, resulting in a 20-minute increase. Anesthesia method further influenced room time, with general anesthesia resulting in an increased room time of 18 minutes compared with spinal or regional anesthesia.
CONCLUSIONS: Obesity is the major driver of increased operative time in total hip arthroplasty. Congestive heart failure, general anesthesia, and morbid obesity each lead to substantial increases in overall room time, with congestive heart failure leading to the greatest increase in overall room time.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was used to identify a cohort of 30,361 patients having total hip arthroplasty between 2006 and 2012. Patient demographics, comorbidities including body mass index, and anesthesia type were used to create generalized linear models identifying independent predictors of increased operative time and room time.
RESULTS: Morbid obesity (body mass index >40) independently increased operative time by 13 minutes and room time 18 by minutes. Congestive heart failure led to the greatest increase in overall room time, resulting in a 20-minute increase. Anesthesia method further influenced room time, with general anesthesia resulting in an increased room time of 18 minutes compared with spinal or regional anesthesia.
CONCLUSIONS: Obesity is the major driver of increased operative time in total hip arthroplasty. Congestive heart failure, general anesthesia, and morbid obesity each lead to substantial increases in overall room time, with congestive heart failure leading to the greatest increase in overall room time.
摘要：
背景：肥胖在进行全髋关节置换术的患者中越来越常见，以前的研究表明，全髋关节置换术与手术时间的增加有关。减少手术时间和房间时间对于满足增加的全髋关节置换术的需求至关重要。和影响这些指标的因素应该量化，以便有针对性地减少时间和调整报销模式。这是第一项使用多变量方法来确定哪些因素会增加全髋关节置换术的手术时间和房间时间的研究。
方法：使用美国外科医师学会国家外科质量改善计划数据库来确定2006年至2012年间进行全髋关节置换术的30,361例患者的队列。患者人口统计学，合并症，包括体重指数，和麻醉类型被用来创建广义线性模型，识别手术时间和房间时间增加的独立预测因素。
结果：病态肥胖（体重指数>40）独立地将手术时间增加了13分钟，将室内时间增加了18分钟。充血性心力衰竭导致整体房间时间的最大增加，增加20分钟。麻醉方法进一步影响房间时间，与脊髓或区域麻醉相比，全身麻醉导致室内时间增加18分钟。
结论：肥胖是全髋关节置换术手术时间增加的主要驱动因素。充血性心力衰竭,全身麻醉,和病态肥胖都会导致整体房间时间的大幅增加，充血性心力衰竭导致整体房间时间的最大增加。
方法：使用美国外科医师学会国家外科质量改善计划数据库来确定2006年至2012年间进行全髋关节置换术的30,361例患者的队列。患者人口统计学，合并症，包括体重指数，和麻醉类型被用来创建广义线性模型，识别手术时间和房间时间增加的独立预测因素。
结果：病态肥胖（体重指数>40）独立地将手术时间增加了13分钟，将室内时间增加了18分钟。充血性心力衰竭导致整体房间时间的最大增加，增加20分钟。麻醉方法进一步影响房间时间，与脊髓或区域麻醉相比，全身麻醉导致室内时间增加18分钟。
结论：肥胖是全髋关节置换术手术时间增加的主要驱动因素。充血性心力衰竭,全身麻醉,和病态肥胖都会导致整体房间时间的大幅增加，充血性心力衰竭导致整体房间时间的最大增加。
