Quality of primary total knee arthroplasty operative reports in a tertiary teaching hospital

Table 1 Descriptive statistics for patients and documentation, n (%)

Case demographics	n = 58
Sex
Female	42 (72.4)
Male	16 (27.6)
Age	63.1 (9.4)
Body mass index	32.4 (28.7-37.3)
Diabetic
Yes	8 (13.8)
No	50 (86.2)
Sequence of the case
First	37 (63.8)
Second	20 (34.5)
Third	1 (1.7)
Complications
LCL injury	1 (1.7)
MCL avulsion	1 (1.7)
Femoral condyle fracture	1 (1.7)
Length of stay in days	4.00 (3.0-4.0)
Duration of operation in minutes	177 (43.1)
Documenter demographics
Level of documenter
R1	4 (6.9)
R2	8 (13.8)
R3	11 (19.0)
R4	31 (53.4)
Registrar	1 (1.7)
Attending consultant	3 (5.2)
Time to documentation in hours	1.5 (0.2-11.7)

LCL: Lateral collateral ligament; MCL: Medial collateral ligament; R1: First year resident; R2: Second year resident; R3: Third year resident; R4: Fourth year resident.

Table 2 Operative report variables

Mandatory variables	n (%)	Optional variables	n (%)
Administrative
Chart number	58 (100)
Date of procedure	58 (100)
Date of dictation	58 (100)
Dictating physician	58 (100)
Median (range)	4.0 (4.0-4.0)
Procedural
Surgeon	58 (100)	Position	57 (98.3)
Assistant	58 (100)
Preoperative diagnosis	37 (63.8)
Postoperative diagnosis	29 (50.0)
Procedure	58 (100)
Type of anesthesia	57 (98.3)
Median (range)	5.5 (3.0-6.0)
Implant data
Manufacturer	50 (86.2)	Patellar implant	1 (1.7)
Femoral component size	54 (93.1)	Use of stems	0 (0)
Tibial component size	54 (93.1)	Use of augments	4 (6.9)
Insert thickness	56 (96.6)
Articular surface type	37 (63.8)
Median (range)	5.0 (1.0-5.0)	Median (range)	0.0 (0.0-2.0)
Clinical data
Indication for surgery	15 (25.9)	Presence of comorbidities	0 (0)
Coronal alignment	0 (0)	Patella tendon Hight	0 (0)
Fixed flexion deformity	0 (0)	Calcified popliteal artery	0 (0)
Ligament testing	0 (0)	Urgency of surgery	0 (0)
Median	0.0 (0.0-1.0)	Median	0.0 (0.0-0.0)
Process
Consent obtained	2 (3.5)	ASA status	0 (0)
Leg marked	2 (3.5)	Timeout performed	23 (39.7)
Antibiotic prophylaxis	34 (58.6)	DVT prophylaxis	0 (0)
Torniquet applied	51 (87.9)	Postoperative NV assessment	5 (8.62)
Torniquet pressure	9 (15.5)
Torniquet duration	26 (44.8)
Use of protective pads	0 (0)
Count of sponges	0 (0)
Disposition	46 (79.3)
Median	3.0 (1.0-5.0)	Median	0.0 (0.0-2.0)

ASA: American Society of Anesthesiologists; DVT: Deep vein thrombosis; NV: Nausea and vomiting.

Table 3 Operative report operative maneuver variable divisions

Mandatory variables	n (%)	Optional variables	n (%)
Exposure
Skin incision	53 (91.4)	Release of LPFL	1 (1.7)
Arthrotomy description	57 (98.3)	Excision of synovium	29 (50.0)
		Excision of fat pad	38 (65.5)
		Patella flipped or slid	47 (81.0)
Median (range)	2.0 (0.0-2.0)	Median (range)	2.0 (0.0-3.0)
Bone cuts and sizing
Sequence of bone cuts	57 (98.3)	Box cutting	22 (37.9)
Degrees of distal femur cut	32 (55.2)
Referencing of distal femur cut	34 (58.6)
Thickness of distal femur cut	3 (5.2)
Degrees of proximal tibia cut	37 (63.8)
Thickness of proximal tibia cut	4 (6.9)
Referencing of proximal tibia cut	34 (58.6)
Femoral sizing	41 (70.7)
Median (range)	5.5 (0.0-8.0)
Position and balancing
Referencing of femoral rotation	32 (55.2)
Referencing of tibial rotation	0 (0)
Extension gap balance in mm	21 (36.2)
Flexion gap balance in mm	17 (29.3)
Description of releases	16 (27.6)
Trial balance finding	56 (96.6)
Trial knee extension degrees	1 (1.7)
Trial knee flexion degrees	4 (6.9)
Median (range)	2.0 (0.0-6.0)
Patella
Patellar tracking	19 (32.8)	Patellar facetectomy	7 (12.1)
Patellar resurfacing performed	0 (0)	Patellar denervation	6 (10.3)
Median (range)	0.0 (0.0-1.0)	Median (range)	0.0 (0.0-2.0)
Closure
Arthrotomy closure	29 (50.0)	Cementing technique	54 (93.1)
Skin closure	53 (91.4)	TXA injection	9 (15.5)
Haemostasias	10 (17.2)	Capsule infiltration	8 (13.8)
Intraoperative complications	7 (12.1)	Use of vancomycin powder	15 (25.9)
		Intraoperative transfusion	0 (0)
		Drain	0 (0)
		Type of dressing	0 (0)
Median (range)	7.0 (1.0-10.0)	Median (range)	2.0 (1.0-5.0)

LPFL: Lateral patellofemoral ligament; TXA: Tranexamic acid.

Table 4 Patient and documenter-related factors associated with documentation quartiles of mandatory items, n (%)

Factors	Q1	Q2	Q3	Q4	P value
Sex					0.152
Female	13 (86.7)	13 (68.4)	12 (80.0)	4 (44.4)
Male	2 (13.3)	6 (31.6)	3 (20.0)	5 (55.6)
Age	63.3 (10.2)	65.7 (8.9)	58.9 (10.1)	64.4 (5.6)	0.208
Body mass index	32.0 (30.7-33.8)	33.2 (27.3-39.0)	33.3 (29.6-38.7)	31.1 (24.1-35.9)	0.542
Diabetes					0.142
No	13 (86.7)	16 (84.2)	15 (100)	6 (66.7)
Yes	2 (13.3)	3 (15.8)	0 (0)	3 (33.3)
Sequence of the case					0.954
First	9 (60.0)	13 (68.4)	9 (60.0)	6 (66.7)
Second	6 (40.0)	6 (31.6)	5 (33.3)	3 (33.3)
Third	0 (0.00)	0 (0.00)	1 (6.7)	0 (0.00)
Operation duration in minutes	175 (32.7)	202 (43.9)	147 (36.8)	180 (37.8)	0.002
Presence of complication					0.353
LCL rupture	0 (0)	1 (5.3)	0 (0)	0 (0)
MCL avulsion	1 (6.7)	0 (0)	0 (0)	0 (0)
Medial condyle fracture	0 (0)	0 (0)	0 (0)	1 (11.1)
Length of hospital stay in days	4.00 (3.00, 4.00)	4.00 (3.00, 4.00)	3.00 (3.00, 4.00)	4.00 (3.00, 5.00)	0.974
Time to documentation in hours	0.40 (0.15-5.21)	0.72 (0.12-4.38)	5.53 (0.54-17.8)	3.18 (0.07-5.08)	0.167
Training level of documenter					0.153
Consultant	0 (0)	2 (10.5)	0 (0)	1 (11.1)
R1	1 (6.7)	0 (0)	1 (6.7)	2 (22.2)
R2	3 (20.0)	2 (10.5)	1 (6.7)	2 (22.2)
R3	1 (6.7)	6 (31.6)	2 (13.3)	2 (22.2)
R4	10 (66.7)	8 (42.1)	11 (73.3)	2 (22.2)
Specialist	0 (0)	1 (5.3)	0 (0)	0 (0)
Grouped training level of the documenter					0.117
Junior resident	4 (26.7)	2 (10.5)	2 (13.3)	4 (44.4)
Senior resident	11 (73.3)	14 (73.7)	13 (86.7)	4 (44.4)
Board certified	0 (0)	3 (15.8)	0 (0)	1 (11.1)

Data were summarized using counts and percentages for categorical variables and median (interquartile range) for continuous variables. Completeness of documentation for all items (mandatory + optional) was divided into quartiles. Analysis was performed using the Kruskal-Wallis test for continuous variables when comparing all quartiles and the Mann-Whitney U test when comparing Q1 to Q4. χ²-test for independence was used to compare categorical variables. LCL: Lateral collateral ligament; MCL: Medial collateral ligament; Q: Quartile; R1: First year resident; R2: Second year resident; R3: Third year resident; R4: Fourth year resident.