Abstract
Aim: Accurate estimation of operation time will reduce operating room costs and increase patient satisfaction. In recent studies, authors have found that thicker adipose tissue at the operation site is associated with a higher rate of complications. However, there is no study in the literature investigating the effect on operation time of an increase in adipose tissue thickness. This present study hypothesized that thicker adipose tissue in shoulder surgeries would prolong the operation time, therefore the study was planned accordingly.
Material and Methods: Preoperative magnetic resonance images of patients applied with rotator cuff repair between 2015 and 2020 were independently evaluated by two observers. The acromial fat thickness was measured as the fat thickness of the operation area, and the scapular fat tissue thickness as the fat thickness of the region relatively far from the operation area. The data obtained were evaluated using multivariate analysis and a binary logistic regression model.
Results: Evaluation was made of a total of 106 patients. The mean total operation time was 89±33 mins. The mean acromial fat thickness was 12.2±4.89 mm and the mean scapular fat thickness was 27.9±12.5mm. The increase in acromial fat thickness was determined to have extended the operation time (OR=5.75, 29.21, p<0.05).
Conclusion: The thickness of fat tissue in the surgical area is one of the factors affecting operating time. Patients can be informed about the risk of prolonged surgery time and associated complications before surgery and costs can be reduced by optimizing operating room planning. In addition, it should be considered that tendinous pathologies may be more common in individuals with increased adipose tissue thickness and thus contribute to prolonging the operation time.
References
- 1. Lee JJ, Odeh KI, Holcombe SA, Patel RD, Wang SC et al. Fat Thickness as a Risk Factor for Infection in Lumbar Spine Surgery. Orthopedics. 2016;39(6):e1124-e1128. doi:10.3928/01477447-20160819-05
- 2. Wagner RA, Hogan SP, Burge JR, Bates CM, Sanchez HB. The Radiographic Prepatellar Fat Thickness Ratio Correlates With Infection Risk After Total Knee Arthroplasty. J Arthroplasty. 2018;33(7):2251-2255. doi:10.1016/j.arth.2018.02.022
- 3. Mehta AI, Babu R, Sharma R, Karikari IO, Grunch BH, Owens TR et al. Thickness of subcutaneous fat as a risk factor for infection in cervical spine fusion surgery. J Bone Joint Surg Am. 2013;95(4):323-328. doi:10.2106/JBJS.L.00225
- 4. Vaidya R, Carp J, Bartol S, Ouellette N, Lee S, Sethi A. Lumbar spine fusion in obese and morbidly obese patients. Spine (Phila Pa 1976). 2009;34(5):495-500. doi:10.1097/BRS.0b013e318198c5f2
- 5. Mehta AI, Babu R, Karikari IO, Grunch B, Agarwal VJ, Owens TR, et al. 2012 Young Investigator Award winner: The distribution of body mass as a significant risk factor for lumbar spinal fusion postoperative infections. Spine, 37(19), 1652–1656. https://doi.org/10.1097/BRS.0b013e318241b186
- 6. Weiss AJ, Elixhauser A, Andrews RM. Characteristics of Operating Room Procedures in U.S. Hospitals, 2011: Statistical Brief #170. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); February 2014.
- 7. Curry EJ, Logan C, Suslavich K, Whitlock K, Berkson E, Matzkin E. Factors impacting arthroscopic rotator cuff repair operational throughput time at an ambulatory care center. Orthop Rev (Pavia). 2018;10(1):7577. Published 2018 Mar 29. doi:10.4081/or.2018.7577
- 8. Lee AV, Moriarty JP, Borgstrom C, Horwitz LI. What can we learn from patient dissatisfaction? An analysis of dissatisfying events at an academic medical center. J Hosp Med. 2010;5(9):514-520. doi:10.1002/jhm.861
- 9. Wu A, Huang CC, Weaver MJ, Urman RD. Use of Historical Surgical Times to Predict Duration of Primary Total Knee Arthroplasty. J Arthroplasty. 2016;31(12):2768-2772. doi:10.1016/j.arth.2016.05.038
- 10. Strum DP, Sampson AR, May JH, Vargas LG. Surgeon and type of anesthesia predict variability in surgical procedure times. Anesthesiology. 2000;92(5):1454-1466. doi:10.1097/00000542-200005000-00036
- 11. DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am. 1984;66(4):563-567.
- 12. Teo BJX, Yeo W, Chong HC, Tan AHC. Surgical site infection after primary total knee arthroplasty is associated with a longer duration of surgery [published correction appears in J Orthop Surg (Hong Kong). 2019 Jan-Apr;27(1):2309499019831607]. J Orthop Surg (Hong Kong). 2018;26(2):2309499018785647. doi:10.1177/2309499018785647
- 13. Boddapati V, Fu MC, Schairer WW, Ranawat AS, Dines DM, Taylor SA et al. Increased Shoulder Arthroscopy Time Is Associated With Overnight Hospital Stay and Surgical Site Infection. Arthroscopy. 2018;34(2):363-368. doi:10.1016/j.arthro.2017.08.243
- 14. Agarwalla A, Gowd AK, Yao K, Bohl DD, Amin NH, Verma NN et al. A 15-Minute Incremental Increase in Operative Duration Is Associated With an Additional Risk of Complications Within 30 Days After Arthroscopic Rotator Cuff Repair. Orthop J Sports Med. 2019;7(7):2325967119860752. Published 2019 Jul 31. doi:10.1177/2325967119860752
- 15. Guglielmi V, Sbraccia P. Obesity phenotypes: depot-differences in adipose tissue and their clinical implications. Eat Weight Disord. 2018;23(1):3-14. doi:10.1007/s40519-017-0467-9
- 16. Machann J, Thamer C, Schnoedt B, et al. Standardized assessment of whole body adipose tissue topography by MRI. J Magn Reson Imaging. 2005;21(4):455-462. doi:10.1002/jmri.20292
- 17. Gaida JE, Ashe MC, Bass SL, Cook JL. Is adiposity an under-recognized risk factor for tendinopathy? A systematic review. Arthritis Rheum. 2009;61(6):840-849. doi:10.1002/art.24518
- 18. Gaida JE, Alfredson H, Kiss ZS, Bass SL, Cook JL. Asymptomatic Achilles tendon pathology is associated with a central fat distribution in men and a peripheral fat distribution in women: a cross sectional study of 298 individuals. BMC Musculoskelet Disord. 2010;11:41. Published 2010 Mar 2. doi:10.1186/1471-2474-11-41
- 19. Kälin PS, Crawford RJ, Marcon M, et al. Shoulder muscle volume and fat content in healthy adult volunteers: quantification with DIXON MRI to determine the influence of demographics and handedness. Skeletal Radiology. 2018;47(10):1393-1402. DOI: 10.1007/s00256-018-2945-1. PMID: 29687149.
- 20. Bravo F, Levi R, Ferrari LR, McManus ML. The nature and sources of variability in pediatric surgical case duration. Paediatr Anaesth. 2015;25(10):999-1006. doi:10.1111/pan.12709
- 21. Alamad, R. A. Surgery Duration Estimation Using Multi-regression Model (Doctoral dissertation, University of Akron). Thesis 2017
Abstract
Amaç: Ameliyat süresinin doğru tahmin edilmesi ameliyathane maliyetlerini azaltacak ve hasta memnuniyetini artıracaktır. Son çalışmalarda yazarlar, operasyon bölgesinde artan yağ dokusunun komplikasyonları arttırdığını bulmuşlardır. Ancak literatürde yağ dokusu kalınlığındaki artışın operasyon süresine etkisini araştıran bir çalışma bulunmamaktadır. Bu çalışmanın hipotezi, omuz bölgesinde artan yağ dokusu kalınlığının ameliyat süresini uzatacağıydı ve çalışma buna göre planlandı.
Yöntemler: 2015-2020 yılları arasında rotator manşet tamiri uygulanan hastaların ameliyat öncesi manyetik rezonans görüntüle3ri iki gözlemci tarafından bağımsız olarak değerlendirildi. Akromiyal yağ kalınlığı operasyon bölgesinin yağ kalınlığı olarak, skapular yağ dokusu kalınlığı ise operasyon bölgesine görece uzak bölgenin yağ kalınlığı olarak ölçüldü. Elde edilen veriler çok değişkenli analiz ve ikili lojistik regresyon modeli kullanılarak değerlendirildi.
Bulgular: Toplam 106 hasta değerlendirildi. Ortalama toplam operasyon süresi 89±33 dakika idi. Ortalama akromiyal yağ kalınlığı 12.2±4.89 mm ve ortalama skapular yağ kalınlığı 27.9±12.5 mm idi. Akromiyal yağ kalınlığındaki artışın operasyon süresini uzattığı belirlendi (OR=5.75, 29.21, p<0.05).
Sonuç: Ameliyat bölgesindeki yağ dokusunun kalınlığı ameliyat süresini etkileyen faktörlerden biridir. Ameliyathane planlaması optimize edilerek hastalar ameliyat öncesi uzamış ameliyat süresinin ve buna bağlı komplikasyonların riskleri hakkında bilgilendirilebilir ve maliyetler düşürülebilir. Ayrıca yağ dokusu kalınlığı artan bireylerde tendinöz patolojilerin daha fazla olabileceği ve bu yollada ameliyatı süresini uzamasına katıkıda bulunabileceği göz önünde bulundurulmalıdır.
References
- 1. Lee JJ, Odeh KI, Holcombe SA, Patel RD, Wang SC et al. Fat Thickness as a Risk Factor for Infection in Lumbar Spine Surgery. Orthopedics. 2016;39(6):e1124-e1128. doi:10.3928/01477447-20160819-05
- 2. Wagner RA, Hogan SP, Burge JR, Bates CM, Sanchez HB. The Radiographic Prepatellar Fat Thickness Ratio Correlates With Infection Risk After Total Knee Arthroplasty. J Arthroplasty. 2018;33(7):2251-2255. doi:10.1016/j.arth.2018.02.022
- 3. Mehta AI, Babu R, Sharma R, Karikari IO, Grunch BH, Owens TR et al. Thickness of subcutaneous fat as a risk factor for infection in cervical spine fusion surgery. J Bone Joint Surg Am. 2013;95(4):323-328. doi:10.2106/JBJS.L.00225
- 4. Vaidya R, Carp J, Bartol S, Ouellette N, Lee S, Sethi A. Lumbar spine fusion in obese and morbidly obese patients. Spine (Phila Pa 1976). 2009;34(5):495-500. doi:10.1097/BRS.0b013e318198c5f2
- 5. Mehta AI, Babu R, Karikari IO, Grunch B, Agarwal VJ, Owens TR, et al. 2012 Young Investigator Award winner: The distribution of body mass as a significant risk factor for lumbar spinal fusion postoperative infections. Spine, 37(19), 1652–1656. https://doi.org/10.1097/BRS.0b013e318241b186
- 6. Weiss AJ, Elixhauser A, Andrews RM. Characteristics of Operating Room Procedures in U.S. Hospitals, 2011: Statistical Brief #170. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); February 2014.
- 7. Curry EJ, Logan C, Suslavich K, Whitlock K, Berkson E, Matzkin E. Factors impacting arthroscopic rotator cuff repair operational throughput time at an ambulatory care center. Orthop Rev (Pavia). 2018;10(1):7577. Published 2018 Mar 29. doi:10.4081/or.2018.7577
- 8. Lee AV, Moriarty JP, Borgstrom C, Horwitz LI. What can we learn from patient dissatisfaction? An analysis of dissatisfying events at an academic medical center. J Hosp Med. 2010;5(9):514-520. doi:10.1002/jhm.861
- 9. Wu A, Huang CC, Weaver MJ, Urman RD. Use of Historical Surgical Times to Predict Duration of Primary Total Knee Arthroplasty. J Arthroplasty. 2016;31(12):2768-2772. doi:10.1016/j.arth.2016.05.038
- 10. Strum DP, Sampson AR, May JH, Vargas LG. Surgeon and type of anesthesia predict variability in surgical procedure times. Anesthesiology. 2000;92(5):1454-1466. doi:10.1097/00000542-200005000-00036
- 11. DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am. 1984;66(4):563-567.
- 12. Teo BJX, Yeo W, Chong HC, Tan AHC. Surgical site infection after primary total knee arthroplasty is associated with a longer duration of surgery [published correction appears in J Orthop Surg (Hong Kong). 2019 Jan-Apr;27(1):2309499019831607]. J Orthop Surg (Hong Kong). 2018;26(2):2309499018785647. doi:10.1177/2309499018785647
- 13. Boddapati V, Fu MC, Schairer WW, Ranawat AS, Dines DM, Taylor SA et al. Increased Shoulder Arthroscopy Time Is Associated With Overnight Hospital Stay and Surgical Site Infection. Arthroscopy. 2018;34(2):363-368. doi:10.1016/j.arthro.2017.08.243
- 14. Agarwalla A, Gowd AK, Yao K, Bohl DD, Amin NH, Verma NN et al. A 15-Minute Incremental Increase in Operative Duration Is Associated With an Additional Risk of Complications Within 30 Days After Arthroscopic Rotator Cuff Repair. Orthop J Sports Med. 2019;7(7):2325967119860752. Published 2019 Jul 31. doi:10.1177/2325967119860752
- 15. Guglielmi V, Sbraccia P. Obesity phenotypes: depot-differences in adipose tissue and their clinical implications. Eat Weight Disord. 2018;23(1):3-14. doi:10.1007/s40519-017-0467-9
- 16. Machann J, Thamer C, Schnoedt B, et al. Standardized assessment of whole body adipose tissue topography by MRI. J Magn Reson Imaging. 2005;21(4):455-462. doi:10.1002/jmri.20292
- 17. Gaida JE, Ashe MC, Bass SL, Cook JL. Is adiposity an under-recognized risk factor for tendinopathy? A systematic review. Arthritis Rheum. 2009;61(6):840-849. doi:10.1002/art.24518
- 18. Gaida JE, Alfredson H, Kiss ZS, Bass SL, Cook JL. Asymptomatic Achilles tendon pathology is associated with a central fat distribution in men and a peripheral fat distribution in women: a cross sectional study of 298 individuals. BMC Musculoskelet Disord. 2010;11:41. Published 2010 Mar 2. doi:10.1186/1471-2474-11-41
- 19. Kälin PS, Crawford RJ, Marcon M, et al. Shoulder muscle volume and fat content in healthy adult volunteers: quantification with DIXON MRI to determine the influence of demographics and handedness. Skeletal Radiology. 2018;47(10):1393-1402. DOI: 10.1007/s00256-018-2945-1. PMID: 29687149.
- 20. Bravo F, Levi R, Ferrari LR, McManus ML. The nature and sources of variability in pediatric surgical case duration. Paediatr Anaesth. 2015;25(10):999-1006. doi:10.1111/pan.12709
- 21. Alamad, R. A. Surgery Duration Estimation Using Multi-regression Model (Doctoral dissertation, University of Akron). Thesis 2017
Details
| Primary Language | English |
|---|---|
| Subjects | Surgery |
| Journal Section | Research Article |
| Authors | |
| Early Pub Date | August 20, 2022 |
| Publication Date | August 20, 2022 |
| Submission Date | April 11, 2022 |
| Acceptance Date | July 2, 2022 |
| Published in Issue | Year 2022 Volume: 6 Issue: 2 |
This Journal is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.