scholarly journals Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures

2015 ◽  
Vol 36 (12) ◽  
pp. 1431-1436 ◽  
Author(s):  
Kristen V. Dicks ◽  
Arthur W. Baker ◽  
Michael J. Durkin ◽  
Deverick J. Anderson ◽  
Rebekah W. Moehring ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Knee Arthroplasty ◽  
Regression Models ◽  
Site Infection ◽  
Operative Duration ◽  
Binomial Regression ◽  
Hip And Knee Arthroplasty ◽  
American Society ◽  
Hip Arthroplasties ◽  
First Time

OBJECTIVETo determine the association (1) between shorter operative duration and surgical site infection (SSI) and (2) between surgeon median operative duration and SSI risk among first-time hip and knee arthroplasties.DESIGNRetrospective cohort studySETTINGA total of 43 community hospitals located in the southeastern United States.PATIENTSAdults who developed SSIs according to National Healthcare Safety Network criteria within 365 days of first-time knee or hip arthroplasties performed between January 1, 2008 and December 31, 2012.METHODSLog-binomial regression models estimated the association (1) between operative duration and SSI outcome and (2) between surgeon median operative duration and SSI outcome. Hip and knee arthroplasties were evaluated in separate models. Each model was adjusted for American Society of Anesthesiology score and patient age.RESULTSA total of 25,531 hip arthroplasties and 42,187 knee arthroplasties were included in the study. The risk of SSI in knee arthroplasties with an operative duration shorter than the 25th percentile was 0.40 times the risk of SSI in knee arthroplasties with an operative duration between the 25th and 75th percentile (risk ratio [RR], 0.40; 95% confidence interval [CI], 0.38–0.56; P<.01). Short operative duration did not demonstrate significant association with SSI for hip arthroplasties (RR, 1.04; 95% CI, 0.79–1.37; P=.36). Knee arthroplasty surgeons with shorter median operative durations had a lower risk of SSI than surgeons with typical median operative durations (RR, 0.52; 95% CI, 0.43–0.64; P<.01).CONCLUSIONSShort operative durations were not associated with a higher SSI risk for knee or hip arthroplasty procedures in our analysis.Infect. Control Hosp. Epidemiol. 2015;36(12):1431–1436

Surgical site infection rate is higher following hip and knee arthroplasty when cefazolin is underdosed

2020 ◽  
Vol 77 (6) ◽  
pp. 434-440 ◽  
Author(s):  
Arthur J Morris ◽  
Sally A Roberts ◽  
Nikki Grae ◽  
Chris M Frampton
Keyword(s):  
Surgical Site Infection ◽  
Knee Arthroplasty ◽  
Multivariable Analysis ◽  
Outcome Data ◽  
Risk Scores ◽  
Site Infection ◽  
Hip And Knee Arthroplasty ◽  
Improvement Programme ◽  
Hip Arthroplasties ◽  
Higher Doses

Abstract Purpose While many guidelines recommend higher doses of cefazolin for patients with higher body weights, there are scant outcome data showing the benefit of higher doses. Surgical site infection (SSI) rates by dose of cefazolin used for surgical prophylaxis after hip or knee arthroplasty were analyzed. Methods Analysis of patient data entered into New Zealand’s national, prospective, surveillance and quality improvement SSI Improvement Programme database for the period July 2013 through December 2017 was conducted. The US Centers for Disease Control and Prevention’s National Healthcare Safety Network SSI definitions were used, and patients were followed for 90 days after surgery. Underdosing was defined as use of 1 g of cefazolin in patients weighing 80 kg or more or a cefazolin dose of &lt;3 g in those weighing 120 kg or more. Results There were 38,288 procedures where cefazolin was used for prophylaxis; patient body weight was known for all these procedures. Of the 1,840 patients who received 1 g of cefazolin, 676 (37%) weighed 80 kg or more. Of the 2,011 patients weighing 120 kg or more, 1,464 (73%) were underdosed. After multivariable analysis, male gender, higher total surgical risk scores, performance of revision and hip arthroplasties, and cefazolin underdosing were associated with higher SSI rates. For the 2,106 underdosed patients, the odds ratio for SSI was 2.19 (95% confidence interval, 1.61-2.99; P &lt; 0.0001). The number of higher-weight patients needed to treat to prevent 1 SSI was 83, with an estimated cost of &lt;NZ$500 to prevent 1 infection costing an estimated NZ$40,000. Conclusion Patients undergoing hip or knee arthroplasty and with weights of ≥80 kg and those with weights of ≥120 kg should receive cefazolin doses of 2 g and ≥3 g, respectively, for SSI prophylaxis. The question of whether a dose of ≥4 g is needed in patients weighing 120 kg or more or who are above a given body mass index threshold (eg, &gt;35 kg/m2 or &gt;40 kg/m2) remains unanswered.

Readmissions after Diagnosis of Surgical Site Infection Following Knee and Hip Arthroplasty

2014 ◽  
Vol 35 (2) ◽  
pp. 152-157 ◽  
Author(s):  
Kyle G. Miletic ◽  
Thomas N. Taylor ◽  
Emily T. Martin ◽  
Rahul Vaidya ◽  
Keith S. Kaye
Keyword(s):  
Surgical Site Infection ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Hospital Admissions ◽  
Site Infection ◽  
Median Cost ◽  
Readmission Rates ◽  
Total Hip ◽  
Hip And Knee Arthroplasty

Context.Surgical site infection (SSI) after total hip and knee arthroplasty is a common postoperative complication. We sought to determine readmission rates and costs for total hip and knee arthroplasty complicated by SSI.Design.The Thomson Reuters MarketScan database was searched for patients who underwent knee or hip arthroplasty in 2007. From these data, patients who received a diagnosis of SSI and were readmitted after diagnosis were identified.Setting.A population of 31 to 45 million individuals receiving insurance coverage. Patients who underwent knee or hip arthroplasty who experienced a hospitalization for SSI in the year after surgery were analyzed.Outcome Measures.Total readmission rates and costs per readmission at 30, 60, and 90 days and 1 year after diagnosis of SSI.Results.Of the 76,289 case patients with hip or knee replacement in 2007, 1,026 (1.3%) had a hospitalization for SSI within the year after surgery. Among these patients, 310 (30.2%) were subsequently rehospitalized in the year after initial hospitalization specifically due to SSI-related issues. These rehospitalizations were associated with a mean hospital stay of 7.4 ± 11.4 days and a median cost of $20,001 (interquartile range [IQR], $14,057-$30,551). A total of 517 subjects had a subsequent “all-cause” hospitalization during the year after SSI. These rehospitalizations were associated with a mean hospital stay of 6.4 ± 10.4 days and a median cost of $19,870 (IQR, $13,913-$29,728).Conclusions.Readmissions during the year after SSI diagnosis accounted for 1,072 hospital admissions and cost over $25.5 million. These readmissions are costly and might be a future target for decreased reimbursement.

Impact of an Automated Surveillance to Detect Surgical-Site Infections in Patients Undergoing Total Hip and Knee Arthroplasty in Brazil

2016 ◽  
Vol 37 (8) ◽  
pp. 991-993 ◽  
Author(s):  
Luciana B. Perdiz ◽  
Deborah S. Yokoe ◽  
Guilherme H. Furtado ◽  
Eduardo A. S. Medeiros
Keyword(s):  
Retrospective Study ◽  
Surgical Site Infection ◽  
Knee Arthroplasty ◽  
Surgical Site Infections ◽  
Infect Control Hosp ◽  
Site Infection ◽  
Total Hip ◽  
Routine Surveillance ◽  
Hip And Knee Arthroplasty ◽  
Automated Surveillance

In this retrospective study, we compared automated surveillance with conventional surveillance to detect surgical site infection after primary total hip or knee arthroplasty. Automated surveillance demonstrated better efficacy than routine surveillance in SSI diagnosis, sensitivity, and predictive negative value in hip and knee arthroplasty.Infect Control Hosp Epidemiol 2016;37:991–993

scholarly journals Surgical site infection after primary total knee arthroplasty is associated with a longer duration of surgery

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901878564 ◽  
Author(s):  
Bryon Jun Xiong Teo ◽  
William Yeo ◽  
Hwei-Chi Chong ◽  
Andrew Hwee Chye Tan
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Surgical Site Infection ◽  
Knee Arthroplasty ◽  
Site Infection ◽  
Operative Duration ◽  
Post Surgery ◽  
Prosthetic Joint Infections ◽  
Duration Of Surgery ◽  
Total Knee

Purpose: Surgical site infection (SSI) is a serious complication following total knee arthroplasty (TKA) leading to considerable morbidity. The incidence is reported to be up to 2%. Risk factors continue to be an area of intense debate. Our study aims to report the incidence of SSI and identify possible risk factors in our patients undergoing TKA. Methods: Prospectively collected data for 905 patients who underwent elective unilateral TKA by a single surgeon from February 2004 to July 2014 were reviewed. Patient demographics and relevant co-morbidities such as diabetes and heart disease were analysed. The presence of superficial wound infections and/or prosthetic joint infections was included. Results: The overall infection rate was 1.10% (10 of 905 patients). Six patients (0.66%) were diagnosed with superficial infections and four with PJI (0.44%). The mean operative duration for TKA with SSI was significantly longer at 90.5 ± 28.2 min, compared to 72.2 ± 20.3 min in TKA without SSI ( p = 0.03). All superficial infections occurred within the first month post-surgery and were self-limiting with oral antibiotics. The four patients with PJI required repeated procedures following TKA, including debridement, implant removal and/or revision arthroplasty. None of the 10 patients had a history of diabetes. There were no significant differences in demographics and co-morbidities between those who developed infection after TKA and those who did not. Conclusion: An overwhelming majority had good outcomes with only four deep infections resulting in revision surgery. We report that the risk of infection in TKA was significantly associated with a longer operative duration.

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