Revision ACL reconstruction has higher incidence of hospital
Revision procedures are inherently more complex and technically challenging. The purpose of this study is to determine the incidence of short-term complications after these procedures and to compare trends in operative length, relative valuation, and reimbursement after primary versus revision ACL reconstruction.

Primary and revision arthroscopic ACL reconstruction cases were identified on NSQIP database using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes. Demographics, patient variables, and surgical variables were compared between primary and revision groups using Chi-squared tests. Various 30-day outcome measures were compared between the primary and revision ACL reconstruction groups. Various measures of valuation—including total relative value units (RVU) and reimbursement per minute—were calculated and compared between the two groups.

Results:
--A total of 8292 patients—8135 primary and 157 revision procedures—were included in the final cohort.

--Higher ASA scores were associated with revision ACL reconstructions.

--Patients undergoing revision procedures were less likely to have an ASA score of 1 and more likely to have an ASA score of 2 or 3.

--Revision ACL reconstruction was associated with higher rates of poor 30-day outcome measures, including unplanned readmission, reoperation, return to the OR, and surgical complications.

--The total RVUs and reimbursement for revision procedures were significantly greater than those for primary procedures.

--However, when accounting for operative time, the RVU/minute and reimbursement/minute were similar between the two groups (n.s.).

In conclusion, revision ACL reconstruction is associated with worse short-term outcomes than primary ACL reconstruction, including unplanned readmission, reoperation, return to the OR, and surgical complications. A higher ASA score was found to be an independent predictor of ACL revision surgery.

Source: https://link.springer.com/article/10.1007/s00167-021-06646-0
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