Risk Factors for Short-term Complications of Anterior Cruciate Ligament Reconstruction in the United States.

Abstract

Anterior cruciate ligament reconstruction (ACLR) is a commonly performed procedure that is highly successful in restoring knee stability and function. The incidence of early ACLR complications and the risk factors for these complications are not well defined. To determine the incidence of 30-day complications and patient and surgical risk factors for complications after ACLR. Cohort study; Level of evidence, 3. Patients who underwent ACLR between 2005 and 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database using Current Procedural Terminology billing codes. Postoperative complications in the 30-day period after surgery were identified. Potential patient and surgical risk factors for 30-day complications after ACLR were analyzed using univariate and multivariate analyses. A total of 4933 patients were identified. Major complications occurred in 27 patients (0.55%), and minor complications occurred in 43 patients (0.87%), with overall complications occurring in 66 patients (1.34%). The most common complications were symptomatic deep venous thrombosis requiring treatment (n = 27; 0.55%), return to the operating room (n = 18; 0.36%), superficial infections (n = 10; 0.20%), deep infections (n = 7; 0.14%), and pulmonary embolism (n = 6; 0.12%). A single mortality (0.02%) occurred. Multivariate analyses demonstrated that smoking, dyspnea, a history of chronic obstructive pulmonary disease, and recent weight loss were all risk factors for the development of overall complications, although in combination, these factors accounted for only 3% of the variance in the complication rate. ACLR has a low incidence of complications (1.34%) in the early postoperative period, with the most common being symptomatic venous thromboembolic disease requiring treatment, return to the operating room, and infections. Because ACLR is an elective procedure, surgeons should use this information to counsel patients on risks and to guide their decision making about patient selection.