Factors Affecting Operative Time Intervals for Lower Limb Arthroplasties - Correlation with Total Operative Time.

PURPOSE OF THE STUDY The aim of this study is to evaluate the operative time intervals for major orthopaedic surgeries and analyze the correlation of different operative factors on total operative time. MATERIAL AND METHODS Specific time intervals; anesthesia release time (ART), surgical preparation time (SPT), operative procedure time (OPT), and anesthesia end time (AET); were recorded by independent observers. Total operative procedure time (TOPT), was also calculated and statisctical correlation analysis was performed between TOPT and study parameters. RESULTS The difference for ART and SPT time intervals between age groups below 65 and 65 to 85 years were found statistically significant. As the patient's age increased, ART and SPT time intervals were also significantly increased. As the patients ASA status increased, the ART intervals were also increased. ART and AET time intervals were significantly longer for residents compared to specialists. DISCUSSION This is one of the first studies in the literature analyzing different time intervals and their correlation on total operative time for major orthopaedic surgeries. Current study also analyzed the effects of other factors including age and ASA score of the patients, type of anesthesia and experience of anesthegiogist on operative time intervals. This study was designed for the analysis of specific time intervals previously described in the literature for only some major orthopaedic surgeries. By this way, we aimed to achieve a homogenous study group and to obtain comparable results with the literature. CONCLUSIONS The strongest correlation was found between ART and TOPT. As the patient's age increased, ART and SPT time intervals were also significantly increased. Increased age and higher ASA scores with an unexperienced anesthegiologist significantly increased the ART intervals. Therefore, reducing ART is the most important factor in reducing TOPT. Key words:arthroplasty, anaesthesia, operation time.

Sacroiliac pain and CT-guided steroid injection treatment: high-grade arthritis has an adverse effect on outcomes in long-term follow-up.

OBJECTIVE: The sacroiliac joint (SIJ) is one of the major sources of low back pain that can lead to severe morbidity. Possible SIJ pain requires a thorough evaluation and treatment option. The purpose of this study was to analyze the possible relationships between computed tomography (CT) grading of SIJ arthritis and the effectiveness of intraarticular steroid injection treatment under CT guidance. PATIENTS AND METHODS: A total of 61 patients with SIJ pain who were treated with CT guided intraarticular steroid injection were retrospectively reviewed. Visual analog scale (VAS) scores for pain control were recorded for short-term (day after injection, first week, third week) and long-term (sixth months and final control) follow-up times. SIJ arthritis was graded using CT images according to the New York criteria. Patients were assigned into low-grade (0, 1 and 2) and high-grade (3 and 4) groups. The relationship between arthritis grades and VAS scores in short and long-term follow-ups were statistically analyzed. RESULTS: Mean age and follow-up was 54.8 years (range: 41-68 years) and 27.8 months (range: 24-36 months), respectively. In 40 patients there was low-grade arthritis, while 21 patients were characterized on having high-grade sacroiliac arthritis detected during the radiological evaluation. There was no statistically significant difference between low and high-grade arthritis in regard to short-term VAS scores. On contrary, for long-term VAS scores, there was significant difference between low- and high-grade arthritis. CONCLUSIONS: Steroid injection treatment for SIJ pain is not effective on a long-term basis for patients with high-grade arthritis, and although they have had decreased VAS scores in the short-term, after 2 years of follow-up, their VAS scores significantly increased leading to symptomatic sacroiliac joint pain.