Factors Associated With Operative Time,Operating Room Idle Time,and Return to the Operating Room for Hip Arthroscopy: An Analysis of 740 Hip Arthroscopies for Femoroacetabular Impingement

Abstract

Background:

Hip arthroscopy is one of the fastest-growing orthopaedic procedures. Minimizing operative time and room idle time may improve patient outcomes and reduce procedural costs.

Purpose:

To identify patient, surgeon, and procedural variables that are associated with operative and idle time that may result in improved patient outcomes.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

All patients undergoing hip arthroscopy for femoroacetabular impingement from 2014 to 2022 were retrospectively reviewed from a multi-institutional health system. Multivariate linear regression was employed using patient age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, annual surgeon hip arthroscopy procedural volume (APV), capsular closure, use of a post, femoroplasty, acetabuloplasty, and labral debridement versus repair. Multivariable logistic regression determined whether operative time or idle time was associated with emergency department visits, readmissions, or returns to the operating room (RTORs) within 1 year.

Results:

A total of 740 hip arthroscopies (704 patients) performed by 25 surgeons were included. Male sex (B = 12.1 minutes; 95% CI, 6.1 to 18.0; P < .001), capsular closure (B = 20.1 minutes; 95% CI, 14.1 to 26.0; P < .001), and femoroplasty (B = 11.5 minutes; 95% CI, 4.7 to 18.3; P < .001) were associated with increased operative time. Age (B = −0.5 minutes; 95% CI, −0.7 to −0.3; P < .001), ASA classification (B = −5.4 minutes; 95% CI, −10.7 to −0.2; P = .04), and APV >25 (B = −33.3 minutes; 95% CI, −39.4 to −27.1; P < .001) were associated with decreased operative time. Use of a post (B = 5.0 minutes; 95% CI, 1.4 to 8.7; P = .007) was associated with increased idle time. APV >25 (B = −15.8 minutes; 95% CI, −18.7 to −12.8; P < .001) and labral repair over debridement (B = −5.9 minutes; 95% CI, −9.7 to −2.2; P = .002) were associated with decreased idle time. Every additional minute of idle time was associated with increased odds of unplanned RTOR for ipsilateral hip pathology within 1 year by 2.3% (95% CI, 1.0%-3.6%; P = .001).

Conclusion:

Our study demonstrated that shorter operative times were associated with several patient-specific factors, including older age and higher ASA classification. Surgeons who performed ≤25 hip arthroscopies per year were associated with longer idle times, and longer idle times were associated with a greater risk of reoperation for ipsilateral hip pathology within 1 year.

Keywords

hip arthroscopy femoroacetabular impingement operative time predictors efficiency

Hip arthroscopy has been recognized as one of the fastest growing orthopaedic procedures in the United States.^5,25,39,43 Its substantial increase in utilization has been guided by improved diagnostic capabilities and technical advancements over recent decades.^{8,9,11,13,18,30} However, as hip arthroscopy becomes popularized by an increasing number of surgeons in broader patient populations and patient care settings, factors associated with its safe and cost-effective performance must be continually studied.^2,35,47,48

Several time-dependent adverse outcomes including increased surgical-site infection risk, prolonged hospital stays, thromboembolic complications, and returns to the operating room (RTORs) have been demonstrated with longer procedural durations among various surgical procedures.^{3,10,15,28,42,46} Despite their relative safety, a direct relationship between surgical time and complications also exists for arthroscopic procedures including higher rates of deep vein thrombosis, pulmonary embolism, and infection.^3,15,28,46 Rates of perioperative complication after arthroscopic procedures of the hip have largely been described in terms of annual surgeon procedural volume (APV) and procedural duration, with higher surgeon volume being among many factors that lower rates of reoperation.¹⁷

Regarding cost utilization, longer duration of care has been identified as a major driver of both total procedural charges for hip arthroscopy and broadly associated with increasing health care expenditures for many orthopaedic procedures.^{4,6,21,34,36,44,45} Bokshan et al⁴ performed a multivariate linear regression and univariate analysis of cost predictors in 14,713 anterior cruciate ligament reconstruction procedures, finding operative time to be a significant cost generator amounting to $108 for each minute of time in the operating room (OR). In the setting of hip arthroscopy, a recent cost prediction analysis identified operative times >98 minutes as one of the strongest measures for increased total charges.³⁶ With the emergence of value-based care models, identifying the predictors of prolonged operative and room time are important to help mitigate patient complications and procedure-related costs.

Literature is limited regarding factors implicated in prolonging surgical time or total OR time during hip arthroscopy. With previous literature linking prolonged operative times to increased rates of postoperative complication, and increased OR time to increased procedure-related costs, additional research is warranted to establish risk factors for both. Therefore, the purpose of this study was to identify surgeon-related, patient-specific, and procedure-related factors that predict operative time and OR idle time. We hypothesized that operative time would decrease with greater surgeon volume and would be prolonged by performing a capsular repair. Additionally, we predicted that idle room time would be influenced by traction setup and patient body mass index (BMI).

Methods

After institutional review board approval was obtained, electronic medical records were obtained for all arthroscopic hip procedures performed within a large, multihospital academic health system between January 1, 2014, and June 15, 2022. Procedures were identified using the Current Procedural Terminology (CPT) identifiers for arthroscopic hip procedures, including 29860, 29861, 29862, 29863, 29916, 29915, and 29914. Inclusion criteria comprised any patient who underwent hip arthroscopy at one of the 11 facilities evaluated within our health system during the aforementioned time frame. A total of 950 hip arthroscopies were initially identified; however, 210 procedures (22.1%) were excluded. Procedures were excluded if they were converted to an open procedure (n = 27), revision procedures (n = 45), had incorrect or insufficient medical coding and/or operative reports (n = 20), or were performed for pathology unrelated to femoroacetabular impingement (FAI) (n = 118). Incorrect medical coding was determined when operations outside of hip arthroscopy were identified via CPT coding. Operative reports were deemed insufficient if they lacked critical information pertaining to the study—namely, operative time and total room time.

The remaining 740 arthroscopic hip procedures in 704 patients (36 staged bilaterals) were included in the analysis. Independent variables comprised various patient-, surgery-, and surgeon-specific factors that were independently documented by 2 reviewers (L.E.B. and B.J.K.). Patient information including age, sex, BMI, American Society of Anesthesiologists (ASA) class, race, and various medical comorbidities were also obtained. Procedure-related factors were recorded from operative reports and perioperative medical documentation including surgical indication, traction setup (post versus postless), labral treatment (repair or debridement), capsular management (capsular repair or not), femoroplasty (performed or not), and acetabuloplasty (performed or not). In addition, the APV was recorded for each surgeon and was defined as the total number of cases performed divided by the total number of years active during the study period. The year 2022 was excluded for this calculation as it was a partially recorded year. Surgeons were stratified into 2 volume-based groups. High-volume surgeons were defined as performing >25 hip arthroscopies per year while low-volume surgeons performed ≤25 than these procedures annually.

Dependent variables consisted of operative time and idle time, as well as unplanned return to the emergency department (ED), readmission, and RTORs all within 1 year. Operative time was defined as the length of time (in minutes) between skin incision and skin closure. Idle time was calculated as the difference between the total room time and operative time.

Statistical analysis was performed with SPSS 28 (IBM Corp). Continuous data are presented as mean ± SD. Multivariate linear regression was utilized to identify predictors of operative time and idle time. Multivariate logistic regression was employed to assess whether operative time or idle time predicted return to the ED, readmission, or RTOR within 1 year. Analyses were performed with the data pooled and partitioned by APV. A P value <.05 with a 95% CI that did not include 0 were used to determine statistical significance.

Results

Of the 740 arthroscopic hip procedures performed in 704 patients, 440 (59.5%) of the procedures were in female patients and the mean age was 36.9 ± 13.8 years (Table 1); 58 hips (7.8%) were <18 years old. A postless traction setup was implemented in 84.2% of cases. Femoroplasty and acetabuloplasty were performed in 61.9% and 62.2% of cases, respectively. Approximately 46.3% of patients underwent both acetabuloplasty and femoroplasty. A total of 96.1% underwent labral treatment procedures—either repair (82.0%) or debridement (18.0%). There were no labral reconstructions in this cohort of primary hip arthroscopy patients. The mean APV was 6.5 ± 11.0 hip arthroscopies for all included surgeons (n = 25). Two surgeons were considered high volume (mean APV, 31.8) and collectively performed 51.6% of the cases. The mean operative time was 95.0 ± 46.5 minutes while the mean idle room time was 58.7 ± 19.3 minutes. Within 1 year of surgery, 10.9% of patients had an ED visit while 6.5% and 4.6% were readmitted and returned to the OR, respectively.

Table 1

Independent and Dependent Variables (n = 740 hips) ^a

Continuous Variables	Mean ± SD
Age, y	36.9 ± 13.8
BMI, kg/m²	27.3 ± 5.8
Operative time, minutes	95.0 ± 46.5
Idle time, minutes	58.7 ± 19.3
Categorical Variables	n (%)
Sex, female	440 (59.5)
ASA classification:
1	196 (26.5)
2	454 (61.4)
3	89 (12.0)
4	1 (0.1)
APV >25 cases/year	382 (51.6)
Capsular closure	391 (52.8)
Use of post	117 (15.8)
Femoroplasty	458 (61.9)
Acetabuloplasty	460 (62.2)
Labral repair	583 (78.8)
Return to ED ≤1 year	81 (10.9)
Readmission <1 year	48 (6.5)
RTOR <1 year	34 (4.6)

APV, annual surgeon procedural volume (number of cases per year); ASA, American Society of Anesthesiologists; BMI, body mass index; ED, emergency department; RTOR, return to operating room.

Multivariate linear regression revealed that male sex (B = 12.1 minutes; 95% CI, 6.1 to 18.0; P < .001), capsular closure (B = 20.1 minutes; 95% CI, 14.1 to 26.0; P < .001), and femoroplasty (B = 11.5 minutes; 95% CI, 4.7 to 18.3; P < .001) increased operative time. In contrast, age (B = −0.5 minutes; 95% CI, −0.7 to −0.3; P < .001), ASA classification (B = −5.4 minutes; 95% CI, −10.7 to −0.2; P = .04), and APV >25 (B = −33.3 minutes; 95% CI, −39.4 to −27.1; P < .001) decreased operative time. BMI, use of a post, acetabuloplasty, and choice of labral management did not affect operative time. Use of a post (B = 5.0 minutes; 95% CI, 1.4 to 8.7; P = .007) increased idle time while APV >25 (B = −15.8 minutes; 95% CI, −18.7 to −12.8; P < .001) and labral repair rather than debridement (B = −5.9 minutes; 95% CI, −9.7 to −2.2; P = .002) decreased idle time. The remaining independent variables did not influence idle time. When the corresponding linear regressions were performed separately based on APV, the low-volume surgeon cohort demonstrated that capsular closure (B = 28.1 minutes; 95% CI, 17.2 to 39.0; P < .001) increased operative time, age (B = −0.8 minutes; 95% CI, −1.2 to −0.3; P = .001) decreased operative time, and use of a post (B = 8.1 minutes; 95% CI, 2.2 to 14.0; P = .008) increased idle time. The high-volume surgeon cohort yielded the same findings for age (B = −0.3 minutes; 95% CI, −0.5 to −0.04; P = .02) and capsular closure (B = 8.8 minutes; 95% CI, 3.2 to 14.4; P = .002), but also showed that male sex (B = 13.5 minutes; 95% CI, 7.7 to 19.3; P < .001), femoroplasty (B = 19.6 minutes; 95% CI, 13.9 to 25.4; P < .001), and acetabuloplasty (B = 6.8 minutes; 95% CI, 1.8 to 11.9; P = .008) increased operative time.

Multivariable logistic regression demonstrated that idle time did not influence return to the ED or readmission rate, but did increase the risk for RTOR in the first postoperative year (B = 1.7%; 95% CI, 0.6-2.8; P = .003). Half of the 34 cases with RTOR <1 year were directly attributed to ipsilateral hip pathology. A breakdown of specific etiologies is listed in Table 2. When only these ipsilateral hip cases were utilized in the regression model, idle time persisted to increase the risk (B = 2.3%; 95% CI, 1.0-3.6; P = .001) of RTOR <1 year. When these data were further subdivided by APV, this relationship between idle time and RTOR <1 only persisted in the low-volume surgeon cohort (B = 2.5%; 95% CI, 0.9-4.0; P = .001). Operative time did not influence return to the ED, readmission, or RTOR within 1 year.

Table 2

Ipsilateral Hip Etiologies for RTOR <1 Year (n = 17 cases) ^a

Etiology	n (%)
Hardware removal	4 (23.5)
Revision hip arthroscopy ^b	5 (29.4)
Arthrogram and steroid injection	1 (5.9)
Gluteus medius repair	1 (5.9)
THA	6 (35.3)

RTOR, return to operating room; THA, total hip arthroplasty.

Revision hip arthroscopy consisted of ≥1 of the following procedures: lysis of adhesions, revision labral repair, revision femoroplasty, or revision acetabuloplasty.

Discussion

The principal findings of this study are that male sex, capsular closure, and femoroplasty were associated with increased operative time. In contrast, age, ASA classification, and APV >25 were associated with decreased operative time. Use of a post was associated with increased idle time. APV >25 and labral repair over debridement were associated with decreased idle time. Every additional minute of idle time was associated with increased odds of unplanned RTOR for ipsilateral hip pathology within 1 year; however, this relationship only persisted in the low-volume surgeon group.

Surgeon Volume

Hip arthroscopy has been well studied in the context of surgeon proficiency.^{6,19,22,24,29,40} In the present investigation, the mean operative time—95.0 minutes—is comparable with values reported in previous literature.¹⁹ Significant reductions in operative time have been observed after a surgeon's first 20 to 30 cases in several series.^22,24,33 However, most volume-based thresholds are arbitrarily chosen and range widely.²⁴ For example, one volume-based outcome study⁴⁰ identified that significantly reduced rates of revision arthroscopy or conversion to total hip arthroplasty (THA) occur after a surgeon's first 519 cases. Out of the surgeons in the present study, those performing >25 hip arthroscopies annually were the only volume-based cohort significantly associated with a decrease in operative time. This is consistent with previous studies that note the inverse relationship between surgeon volume and procedural duration.^{6,17,19,29,40} However, the range of competency marks and methodologies used to define surgeon experience offers little consensus in defining the relationship between surgeon proficiency, measures of operative time, and patient safety.

Measures of idle time are less frequently reported in the literature and can be obscurely described. Of studies with defined measures, Dumont et al¹⁹ reported a mean “setup” and “wake-up” time of 39.8 minutes across a series of 225 consecutive patients. Furthermore, the authors observed that these times remained relatively consistent regardless of surgeon experience. This finding contrasts the present study—surgeons who performed >25 hip arthroscopies annually were associated with approximately 16 fewer minutes of idle time than surgeons with a smaller surgical volume. This may reflect surgeon and OR staff familiarity, as a greater number of cases allows both parties to be more efficient with the required materials and setup.

Procedure-Related Factors

Postless traction systems have gained significant popularity among hip arthroscopists largely because of their potential superior safety profile compared with conventional techniques.^16,32,41 In the present study, postless traction was more popular and was associated with decreased idle time by 5 minutes. Five minutes may not appear to be a substantial amount of time; however, time-related factors heavily influence ambulatory and hospital OR budgets, and the higher initial costs associated with proprietary postless traction systems may be justified by long-term savings.^4,34,36 Additionally, some authors have described cost-effective means of achieving postless traction using standard hip distraction tables.^16,31

Capsular closure was performed in just over half of cases and was associated with approximately 20 minutes of operative time. Although a growing amount of literature has advocated for capsular repair in the management of FAI, it was performed more sparingly than labral repair, acetabuloplasty, or femoroplasty in the present cohort.^{1,11,18,20,23} Considering that labral repair and acetabuloplasty were not associated with operative time in the pooled data, the prolonging effect of capsular repair may be related to surgeon inexperience and perhaps a steeper learning curve for this component of the procedure. The subanalyses by APV support this possibility, as capsular repair was associated with increased operative time by an additional 20 minutes in the low-volume cohort compared with their high-volume counterparts. In contrast, for femoroplasty, the high-volume cohort had an increase in procedural duration of 19.6 minutes, compared with only 11.5 minutes for the cohort as a whole. An adequate femoroplasty requires time and meticulous surgical technique. Inexperienced surgeons may not resect sufficient femoral neck to fully remove a cam lesion and thus may perform this portion of the procedure in a shorter amount of time. Alternatively, ease of femoroplasty is directly affected by proper exposure, which may be related to a larger capsulotomy, especially by less experienced surgeons.²³ As a result, this larger capsulotomy may then prompt some surgeons to perform a more extensive and time-consuming capsular closure.

Despite the increased technical demands of labral repair compared with debridement, performing the former was not associated with increased operative time. Instead, labral repair was associated with a decreased idle time by almost 6 minutes. This may be explained by surgeon and OR staff experience. More experienced hip arthroscopists may take on patients with larger labral tears or may be more willing to attempt a repair on a more degenerated labrum. Given that these more seasoned surgeons likely perform a greater number of cases, the OR staff is more familiar and efficient with the specific setup.

Patient Factors

Male sex was associated with increased operative time by approximately 12 minutes while age and ASA classification were both inversely correlated. Every 1-year increase in age or 1-stage increase in ASA classification was associated with an operative time decrease of 0.5 minutes and roughly 5 minutes, respectively. Earlier studies have concluded that older patients are more likely to receive temporizing procedures such as chondroplasty or labral debridement rather than repair.⁴³ By similar logic, patients with higher ASA classifications are more likely to be older, and surgeons may be more motivated to minimize operative time to limit the risks of prolonged anesthesia. Conversely, BMI was not associated with operative time, which is atypical in the context of other arthroscopic procedures. Previous investigations reported elevated BMI as prolonging operative times for both arthroscopic rotator cuff repair and anterior cruciate ligament reconstruction.^3,15 It is possible that the use of longer cameras and instrumentation in hip arthroscopy may mitigate some of the challenges of increased BMI. Additionally, the health system where the present study was performed utilizes radiographic guidance when establishing hip arthroscopy portals. The widespread utilization of fluoroscopy may reduce the unique challenges and additional operative time that come with identifying anatomic landmarks in higher BMI patients.

RTOR

Within 1 year of the index surgery, the RTOR rate was 4.6% for any reason and 2.3% for etiologies involving the ipsilateral hip. Some earlier studies report a 10-fold lower RTOR rate at 0.4% and 0.3%; however, both investigations utilized the National Surgical Quality Improvement Program database, which only provides data up to 30 days postoperatively and does not always list a clear etiology.^14,27 This temporal relationship is further illustrated in a systematic review of 92 studies (6134 patients) that yielded an RTOR rate of 6.3% after a mean of 16.4 ( +/−15.1) months.²⁶ The most common reported reason was conversion to THA, most notably in older patients and those with preexisting hip osteoarthritis. While older age, higher ASA classification, and BMI have also been associated with higher rates of postoperative complications, reoperation, or overnight hospital stay following hip arthroscopy, a paucity of research has examined the relationship between operative or idle times and RTOR.^12,17,44 In the present investigation, every additional minute of idle time was associated with increased risk of RTOR by 1.7%. When the etiologies for RTOR were isolated to only those involving the ipsilateral hip, the risk rose to 2.3% per minute. When isolated to low-volume surgeons, the risk grew slightly higher to 2.5% per minute.

Limitations

This study is not without limitations. First, this is a retrospectively performed study that can demonstrate association, but not cause and effect, while also being prone to potential error in data entry including the interpretation of diagnoses and procedural information. Additionally, our patient-surgeon cohort was sampled from a regional health system, which may be less generalizable to different populations (such as those from nonacademic institutions) when compared with national registry studies or those from specialized, high-volume hip arthroscopy centers. In our multivariate model, it should be noted that the surgeon APV threshold of 25 was determined subjectively based on our own data and does not represent statistically validated cutoffs for performance. Future research is warranted to better establish the relationship between a wide variety of surgeon APV cutoffs and operative time. Moreover, the utilization of osteoplasties was reported without radiographic evaluation, which may have more accurately predicted their effect on procedural duration. Additional studies correlating radiographic parameters with operative times could be beneficial. Last, surgeon fellowship training was not reported in this study. While the effect of fellowship training on operative or room time is not documented in hip arthroscopy, it has been shown to affect patient outcomes and technique utilization in other orthopaedic disciplines.^7,37,38

Conclusion

Footnotes

Final revision submitted May 15, 2025; accepted July 1, 2025.

The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Ethical approval for this study was obtained from Northwell Health (No. LIJVS 22-0698).

ORCID iDs

Brandon J. Klein

Randy M. Cohn

References

Atzmon

Sharfman

Haviv

, et al. Does capsular closure influence patient-reported outcomes in hip arthroscopy for femoroacetabular impingement and labral tear? J Hip Preserv Surg. 2019;6(3):199-206. doi:10.1093/jhps/hnz025

Awad

MAH

Bajwa

Slaunwhite

Logan

Wong

. Indications for hip arthroscopy in pediatric patients a systematic review. J Hip Preserv Surg. 2019;6(4):304-315. doi:10.1093/jhps/hnz056

Boddapati

Schairer

, et al. Increased shoulder arthroscopy time is associated with overnight hospital stay and surgical site infection. Arthroscopy. 2018;34(2):363-368. doi:10.1016/j.arthro.2017.08.243

Bokshan

Mehta

DeFroda

Owens

BD.

What are the primary cost drivers of anterior cruciate ligament reconstruction in the United States? A cost-minimization analysis of 14,713 patients. Arthroscopy. 2019;35(5):1576-1581. doi:10.1016/j.arthro.2018.12.013

Bonazza

Homcha

Liu

Leslie

Dhawan

Surgical trends in arthroscopic hip surgery using a large national database. Arthroscopy. 2018;34(6):1825-1830. doi:10.1016/j.arthro.2018.01.022

Bovonratwet

Boddapati

Nwachukwu

Bohl

Nho

SJ.

Increased hip arthroscopy operative duration is an independent risk factor for overnight hospital admission. Knee Surg Sports Traumatol Arthrosc. 2021;29(5):1385-1391. doi:10.1007/s00167-020-06170-7

Bram

DeFrancesco

Pascual-Leone

Gross

Doyle

Fabricant

PD.

Impact of pediatric orthopaedic fellowship training on pediatric supracondylar humerus fracture treatment and outcomes: a meta-analysis. J Pediatr Orthop. 2023;43(1):e86-e92. doi:10.1097/BPO.0000000000002281

Chandrasekaran

Darwish

Chaharbakhshi

Suarez-Ahedo

Lodhia

Domb

BG.

Minimum 2-year outcomes of hip arthroscopic surgery in patients with acetabular overcoverage and profunda acetabulae compared with matched controls with normal acetabular coverage. Am J Sports Med. 2017;45(11):2483-2492. doi:10.1177/0363546517708769

Chen

Yuen

Ortiz-Declet

Litrenta

Maldonado

Domb

BG.

Selective debridement with labral preservation using narrow indications in the hip: minimum 5-year outcomes with a matched-pair labral repair control group. Am J Sports Med. 2018;46(2):297-304. doi:10.1177/0363546517739566

10.

Clapp

Marrero

Corbett

, et al. Effect of operative times in bariatric surgery on outcomes: a matched analysis of the MBSAQIP database. Surg Endosc. 2023;37(6):4113-4122. doi:10.1007/s00464-023-09927-6

11.

Cohen

Comeau-Gauthier

Khan

, et al. A higher proportion of patients may reach the MCID with capsular closure in patients undergoing arthroscopic surgery for femoroacetabular impingement: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022;30(7):2425-2456. doi:10.1007/s00167-022-06877-9

12.

Collins

Beutel

Garofolo

Youm

Correlation of obesity with patient-reported outcomes and complications after hip arthroscopy. Arthroscopy. 2015;31(1):57-62. doi:10.1016/j.arthro.2014.07.013

13.

Crawford

Alexander

, et al. The 2007 Frank Stinchfield award: the biomechanics of the hip labrum and the stability of the hip. Clin Orthop Relat Res. 2007;465:16-22. doi:10.1097/BLO.0b013e31815b181f

14.

Cvetanovich

Chalmers

Levy

, et al. Hip arthroscopy surgical volume trends and 30-day postoperative complications. Arthroscopy. 2016;32(7):1286-1292. doi:10.1016/j.arthro.2016.01.042

15.

Cvetanovich

Chalmers

Verma

Cole

Bach

BR.

Risk factors for short-term complications of anterior cruciate ligament reconstruction in the United States. Am J Sports Med. 2016;44(3):618-624. doi:10.1177/0363546515622414

16.

Decilveo

Kraeutler

Dhillon

, et al. Postless arthroscopic hip preservation can be adequately performed using published techniques. Arthrosc Sports Med Rehabil. 2023;5(1):e273-e280. doi:10.1016/j.asmr.2022.09.013

17.

Degen

Pan

Chang

, et al. Risk of failure of primary hip arthroscopy—a population-based study. J Hip Preserv Surg. 2017;4(3):214-223. doi:10.1093/jhps/hnx018

18.

Domb

Chaharbakhshi

Perets

Walsh

Yuen

Ashberg

LJ.

Patient-reported outcomes of capsular repair versus capsulotomy in patients undergoing hip arthroscopy: minimum 5-year follow-up—a matched comparison study. Arthroscopy. 2018;34(3):853-863.e1. doi:10.1016/j.arthro.2017.10.019

19.

Dumont

Cohn

Gross

Menge

Battle

Thier

ZT.

The learning curve in hip arthroscopy: effect on surgical times in a single-surgeon cohort. Arthroscopy. 2020;36(5):1293-1298. doi:10.1016/j.arthro.2019.11.121

20.

Economopoulos

Chhabra

Kweon

Prospective randomized comparison of capsular management techniques during hip arthroscopy. Am J Sports Med. 2020;48(2):395-402. doi:10.1177/0363546519894301

21.

Fabricant

Seeley

Rozell

, et al. Cost savings from utilization of an ambulatory surgery center for orthopaedic day surgery. J Am Acad Orthop Surg. 2016;24(12):865-871. doi:10.5435/JAAOS-D-15-00751

22.

Flores

Borak

Zhang

AL.

Hip arthroscopic surgery for femoroacetabular impingement: a prospective analysis of the relationship between surgeon experience and patient outcomes. Orthop J Sports Med. 2018;6(2):2325967118755048. doi:10.1177/2325967118755048

23.

Frank

Lee

Bush-Joseph

Kelly

Salata

Nho

SJ.

Improved outcomes after hip arthroscopic surgery in patients undergoing T-capsulotomy with complete repair versus partial repair for femoroacetabular impingement: a comparative matched-pair analysis. Am J Sports Med. 2014;42(11):2634-2642. doi:10.1177/0363546514548017

24.

Kyin

Maldonado

Domb

BG.

Surgeon experience in hip arthroscopy affects surgical time, complication rate, and reoperation rate: a systematic review on the learning curve. Arthroscopy. 2020;36(12):3092-3105. doi:10.1016/j.arthro.2020.06.033

25.

Hale

Melugin

Zhou

, et al. Incidence of femoroacetabular impingement and surgical management trends over time. Am J Sports Med. 2021;49(1):35-41. doi:10.1177/0363546520970914

26.

Harris

McCormick

Abrams

, et al. Complications and reoperations during and after hip arthroscopy: a systematic review of 92 studies and more than 6,000 patients. Arthroscopy. 2013;29(3):589-595. doi:10.1016/j.arthro.2012.11.003

27.

Hartwell

Morgan

Johnson

, et al. Risk factors for 30-day readmission following hip arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2020;28(4):1290-1295. doi:10.1007/s00167-019-05415-4

28.

Hetsroni

Lyman

Mann

Marx

RG.

Symptomatic pulmonary embolism after outpatient arthroscopic procedures of the knee: the incidence and risk factors in 418 323 arthroscopies. J Bone Joint Surg Br. 2011;93(1):47-51. doi:10.1302/0301-620X.93B1.25498

29.

Hoppe

De Sa

Simunovic

, et al. The learning curve for hip arthroscopy: a systematic review. Arthroscopy. 2014;30(3):389-397. doi:10.1016/j.arthro.2013.11.012

30.

Johannsen

Ruzbarsky

Pierpoint

Soares

Briggs

Philippon

MJ.

No correlation between depth of acetabuloplasty or postoperative lateral center-edge angle on midterm outcomes of hip arthroscopy with acetabuloplasty and labral repair. Am J Sports Med. 2021;49(1):49-54. doi:10.1177/0363546520972998

31.

Kollmorgen

Ellis

Lewis

Harris

JD.

Achieving post-free distraction in hip arthroscopy with a pink pad patient positioning device using standard hip distraction tables. Arthrosc Tech. 2019;8(4):e363-e368. doi:10.1016/j.eats.2018.11.013

32.

Kraeutler

Fasulo

Dávila Castrodad

Mei-Dan

Scillia

AJ.

A prospective comparison of groin-related complications after hip arthroscopy with and without a perineal post. Am J Sports Med. 2023;51(1):155-159. doi:10.1177/03635465221130768

33.

Lee

Hwang

Koo

KH.

Learning curve of basic hip arthroscopy technique: CUSUM analysis. Knee Surg Sports Traumatol Arthrosc. 2013;21(8):1940-1944. doi:10.1007/s00167-012-2241-x

34.

Chuck

Bokshan

, et al. High-volume and privately owned ambulatory surgical centers reduce costs in Achilles tendon repair. Orthop J Sports Med. 2020;8(4):2325967120912398.

35.

Lindman

Öhlin

Desai

, et al. Five-year outcomes after arthroscopic surgery for femoroacetabular impingement syndrome in elite athletes. Am J Sports Med. 2020;48(6):1416-1422. doi:10.1177/0363546520908840

36.

Lavoie-Gagne

Forlenza

, et al. Duration of care and operative time are the primary drivers of total charges after ambulatory hip arthroscopy: a machine learning analysis. Arthroscopy. 2022;38(7):2204-2216.e3. doi:10.1016/j.arthro.2021.12.012

37.

Mabry

Cichos

McMurtrie

Pearson

McGwin

Ghanem

ES.

Does surgeon fellowship training influence outcomes in hemiarthroplasty for femoral neck fracture?

J Arthroplasty. 2019;34(9):1980-1986. doi:10.1016/j.arth.2019.04.038

38.

Mahure

Feng

Schwarzkopf

Long

WJ.

The impact of arthroplasty fellowship training on total joint arthroplasty: comparison of peri-operative metrics between fellowship-trained surgeons and non-fellowship-trained surgeons. J Arthroplasty. 2020;35(10):2820-2824. doi:10.1016/j.arth.2020.05.027

39.

Maradit Kremers

Schilz

Van Houten

, et al. Trends in utilization and outcomes of hip arthroscopy in the United States between 2005 and 2013. J Arthroplasty. 2017;32(3):750-755. doi:10.1016/j.arth.2016.09.004

40.

Mehta

Chamberlin

Marx

, et al. Defining the learning curve for hip arthroscopy: a threshold analysis of the volume-outcomes relationship. Am J Sports Med. 2018;46(6):1284-1293. doi:10.1177/0363546517749219

41.

Mei-Dan

Kraeutler

Garabekyan

Goodrich

Young

DA.

Hip distraction without a perineal post: a prospective study of 1000 hip arthroscopy cases. Am J Sports Med. 2018;46(3):632-641. doi:10.1177/0363546517741704

42.

Poles

Stafford

Francone

Roberts

Ricciardi

What is the relationship between operative time and adverse events after colon and rectal surgery?

Am Surg. 2018;84(5):712-716.

43.

Schairer

Nwachukwu

Suryavanshi

Yen

Kelly

Fabricant

PD.

A shift in hip arthroscopy use by patient age and surgeon volume: a New York State–based population analysis 2004 to 2016. Arthroscopy. 2019;35(10):2847-2854.e1. doi:10.1016/j.arthro.2019.05.008

44.

Song

Wilbur

, et al. Machine learning model identifies increased operative time and greater BMI as predictors for overnight admission after outpatient hip arthroscopy. Arthrosc Sports Med Rehabil. 2021;3(6):e1981-e1990. doi:10.1016/j.asmr.2021.10.001

45.

Tiao

Wang

Carbone

, et al. Ambulatory surgery centers significantly decrease total health care expenditures in primary anterior cruciate ligament reconstruction. Am J Sports Med. 2023;51(1):97-106. doi:10.1177/03635465221136542

46.

Westermann

Pugely

Ries

, et al. Causes and predictors of 30-day readmission after shoulder and knee arthroscopy: an analysis of 15,167 cases. Arthroscopy. 2015;31(6):1035-1040.e1. doi:10.1016/j.arthro.2015.03.029

47.

Zhong

Zhu

Ouyang

Hip arthroscopy successfully treats femoroacetabular impingement in adolescent athletes. J Pediatr Orthop. 2021;41(1):e98. doi:10.1097/BPO.0000000000001559

48.

Zusmanovich

Haselman

Serrano

Banffy

The incidence of hip arthroscopy in patients with femoroacetabular impingement syndrome and labral pathology increased by 85% between 2011 and 2018 in the United States. Arthroscopy. 2022;38(1):82-87. doi:10.1016/j.arthro.2021.04.049