# A Service Evaluation of the Operative Length of Anterior Cruciate Ligament Reconstruction and Associated Procedures

## TL;DR

This study examines how factors like age and procedure type affect the length of ACL surgery and hospital stays, with insights for improving surgical efficiency.

## Contribution

The study identifies specific predictors of operative time and hospital stay in ACL reconstruction, particularly for complex procedures like LET.

## Key findings

- Older patients had shorter operative times and longer hospital stays.
- LET procedures were associated with prolonged hospital stays and were mainly performed on younger patients.
- Postoperative complications were more common in older patients.

## Abstract

Background

The Getting It Right First Time (GIRFT) initiative emphasises pathway efficiency to achieve optimal surgical outcomes. While anterior cruciate ligament (ACL) reconstruction is common, the factors influencing operative duration and their relationship with patient characteristics and outcomes remain poorly understood, especially concerning complex procedures such as lateral extra-articular tenodesis (LET).

Methodology

This service evaluation analysed 157 ACL reconstructions at a major UK teaching hospital from 2019 to 2023. Procedures were categorised as isolated ACL reconstruction, ACL with meniscal repair, ACL with LET, or ACL and combined procedures. A multiple regression analysis evaluated predictors of operative time while assessing perioperative outcomes and readmission rates.

Results

Age independently predicted shorter operative times (-0.696 minutes/year, p = 0.005). LET procedures exhibited longer operative times but were mainly performed on younger, lower body mass index patients. An American Society of Anesthesiologists III status had an impact on the length of stay (hazard ratio (HR) = 0.440, 95% confidence interval (CI) = 0.276-0.704, p = 0.001), and ACL + LET procedures (HR = 0.466, 95% CI = 0.250-0.866, p = 0.016) were associated with significantly prolonged stays. Postoperative complications occurred in 6.4% (10/157) of cases, with significant age-related patterns observed. Affected patients were notably older (mean = 46.0 years, 95% CI = 39.2-52.8) compared to those without complications (mean = 26.6 years, 95% CI = 24.9-28.3).

Conclusions

This GIRFT-aligned analysis shows that age and procedure type significantly affect the duration of ACL reconstruction, highlighting distinct patterns in LET procedures. These findings indicate opportunities for optimising pathways through scheduling and procedure-specific postoperative protocols, particularly for complex cases.