Revision ACL reconstruction has higher incidence of 30-day hospital readmission, reoperation, and surgical complications relative to primary procedures

Jeremy S. Marx, Mark A. Plantz*, Erik B. Gerlach, John Carney, Peter R. Swiatek, Colin K. Cantrell, Vehniah K. Tjong

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Purpose: Although there has been substantial improvement in ACL reconstructive surgery, graft failure remains a devastating complication for some patients. 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. Methods: Primary and revision arthroscopic ACL reconstruction cases were identified on the American College of Surgeons’ NSQIP database using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes between January 1, 2012 and December 31, 2017. Demographics, patient variables, and surgical variables were compared between primary and revision groups using Chi-squared tests. Logistic regression was used to identify independent risk factors for revision ACL reconstruction. 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 (p < 0.001) and more likely to have an ASA score of 2 (p = 0.004) or 3 (p = 0.020). Revision ACL reconstruction was associated with higher rates of poor 30-day outcome measures, including unplanned readmission (p = 0.029), reoperation (p = 0.012), return to the OR (p = 0.012), and surgical complications (p = 0.021). The total RVUs and reimbursement for revision procedures were significantly greater than those for primary procedures (p < 0.001). However, when accounting for operative time, the RVU/minute and reimbursement/minute were similar between the two groups (n.s.). Conclusions: Relative to primary ACL reconstruction, revision ACL procedures are associated with worse short-term outcomes—including unplanned readmission, reoperation, return to the OR, and surgical complications. A greater ASA score was independently predictive of revision ACL surgery. The current RVU system undervalues revision ACL procedures, considering the increased operative time and complexity of such procedures. Level of evidence: Level III.

Original languageEnglish (US)
Pages (from-to)1605-1610
Number of pages6
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Issue number5
StatePublished - May 2022

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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