Risk Factors for Hospital Admission After Anterior Cruciate Ligament Reconstruction

Purpose: To determine patient and surgical risk factors for admission after anterior cruciate ligament reconstruction (ACLR) using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Methods: All instances of ACLR from 2005 to 2014 from the ACS NSQIP prospective database were analyzed. Both univariate analysis and binary logistic regression were performed to determine which patient demographics and medical comorbidities were associated with admission after surgery. Results: Of the 9,146 patients undergoing ACLR, 1,197 (13.1%) required admission. Univariate analysis found that the following variables were associated with the need for admission: decreased age, Hispanic ethnicity, higher American Society of Anesthesiologists class, higher Charlson Comorbidity Index, use of an epidural anesthesia, longer operative times, prior operation within 30 days, dyspnea, smoking, diabetes, chronic obstructive pulmonary disease, previous cardiac surgery, hypertension, previous revascularization procedure, and a known bleeding disorder. Independent predictors of admission on multivariate analysis included Hispanic ethnicity (odds ratio [OR] 8.9), use of epidural anesthesia (OR 6.3), known bleeding disorder (OR 4.02), increased body mass index (OR 1.03), longer operation time (OR 1.012), and younger age (OR 1.008). Conclusions: Our study identifies Hispanic ethnicity, use of epidural anesthesia, and history of bleeding disorder as major independent risk factors for admission after ACLR.