Impact of operative time on short-term adverse events following total shoulder arthroplasty

Background: Previous investigations have identified patient demographics and procedural characteristics, including operative time, as risk factors for adverse events following total shoulder arthroplasty (TSA). However, many of these risk factors are unmodifiable by physicians. Extended operative time is a partially modifiable variable that has not been fully investigated in its contribution to the incidence of postoperative complications after TSA. The purpose of this study was to investigate whether a 15-min increase in operative time is an independent predictor of adverse events occurring within 30 days following TSA. Methods: 10,424 TSAs from 2015 to 2017 were queried from the National Surgical Quality Improvement Program database. Bivariate and multivariate binomial logistic regression was performed to investigate the association between a 15-min increase in operative time and the likelihood of developing short-term postoperative adverse events. The statistical analyses were conducted using SPSS Software version 26.0 (IBM Corp., Armonk, NY, USA). The level of significance was set at p<0.05. Results: Multivariate analysis, adjusting for all significantly associated demographics, comorbidities, and procedural characteristics, revealed that a 15-min increase in operative time was associated with an increased likelihood of anemia requiring transfusion, pulmonary embolism, acute renal failure, unplanned reoperation, extended length of stay (≥3 days), and any adverse event within 30 days of TSA (all p<0.05). Higher BMI, younger age, male sex, general anesthesia, and preoperative anemic status predicted longer operative duration. Conclusion: A 15-min increase in operative time is a significant risk factor for postoperative complications, unplanned reoperation, and extended length of stay within 30 days of TSA.