Surgical duration is associated with an increased risk of periprosthetic infection following total knee arthroplasty: A population-based retrospective cohort study.
Arthroplasty
Infection
Surgical duration
Journal
EClinicalMedicine
ISSN: 2589-5370
Titre abrégé: EClinicalMedicine
Pays: England
ID NLM: 101733727
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
received:
18
07
2019
revised:
12
09
2019
accepted:
17
09
2019
entrez:
14
12
2019
pubmed:
14
12
2019
medline:
14
12
2019
Statut:
epublish
Résumé
Total knee arthroplasty (TKA) is one the most common elective procedures in the world. Post-operative infection is one of its most devastating complications, often necessitating multiple additional surgeries. We aimed to describe the relationship between surgical duration and risk of deep infection following primary elective TKA. In this cohort study we analyses primary TKAs done between 2009 and 2016 in Ontario, Canada. We utilized restricted cubic splines to identify a threshold of surgical duration that was associated with an increased risk for infection requiring surgery. Patients with a 'short' duration of surgery were matched to those with a 'long' duration on patient age (±3 years), patient sex, severe obesity (BMI > 40), the primary surgeon, the hospital and the type of anesthetic. In 92,343 primary TKAs, the median surgical duration was 106 min. We identified a cut-point of 100 min that was associated with an increased risk for infection. Subsequently, 17,815 TKA recipients with a 'long' procedure length were matched to those with a 'short' procedure length. 'Long' procedures had a higher rate of deep infection (1.1% versus 0.6%, In a cohort of TKA recipients, we found that procedure lengths longer than 100 min were associated with a significantly increased risk of deep infection requiring surgery. This time threshold serves a useful time-point to identify patients that require closer surveillance.
Sections du résumé
BACKGROUND
BACKGROUND
Total knee arthroplasty (TKA) is one the most common elective procedures in the world. Post-operative infection is one of its most devastating complications, often necessitating multiple additional surgeries. We aimed to describe the relationship between surgical duration and risk of deep infection following primary elective TKA.
METHODS
METHODS
In this cohort study we analyses primary TKAs done between 2009 and 2016 in Ontario, Canada. We utilized restricted cubic splines to identify a threshold of surgical duration that was associated with an increased risk for infection requiring surgery. Patients with a 'short' duration of surgery were matched to those with a 'long' duration on patient age (±3 years), patient sex, severe obesity (BMI > 40), the primary surgeon, the hospital and the type of anesthetic.
FINDINGS
RESULTS
In 92,343 primary TKAs, the median surgical duration was 106 min. We identified a cut-point of 100 min that was associated with an increased risk for infection. Subsequently, 17,815 TKA recipients with a 'long' procedure length were matched to those with a 'short' procedure length. 'Long' procedures had a higher rate of deep infection (1.1% versus 0.6%,
INTERPRETATION
CONCLUSIONS
In a cohort of TKA recipients, we found that procedure lengths longer than 100 min were associated with a significantly increased risk of deep infection requiring surgery. This time threshold serves a useful time-point to identify patients that require closer surveillance.
Identifiants
pubmed: 31832622
doi: 10.1016/j.eclinm.2019.09.015
pii: S2589-5370(19)30167-1
pmc: PMC6890965
doi:
Types de publication
Journal Article
Langues
eng
Pagination
74-80Informations de copyright
© 2019 Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
The authors do not have any conflicts of interest.
Références
JAMA. 2004 Apr 21;291(15):1864-70
pubmed: 15100205
J Arthroplasty. 2019 Mar;34(3):426-432
pubmed: 30528133
Pulm Med. 2012;2012:818925
pubmed: 23097698
J Gerontol A Biol Sci Med Sci. 2010 Apr;65(4):377-81
pubmed: 19942592
J Clin Epidemiol. 2008 Sep;61(9):882-9
pubmed: 18468859
Osteoarthritis Cartilage. 2015 Apr;23(4):594-600
pubmed: 25579802
J Arthroplasty. 2019 Jul;34(7S):S331-S336
pubmed: 30545655
Clin Orthop Relat Res. 2014 Jul;472(7):2197-200
pubmed: 24615421
Surg Infect (Larchmt). 2017 Aug/Sep;18(6):722-735
pubmed: 28832271
Am J Infect Control. 2011 Jun;39(5):349-67
pubmed: 21774120
Lipids. 2003 Feb;38(2):103-8
pubmed: 12733740
Health Place. 2011 Jan;17(1):361-9
pubmed: 21177136
J Bone Joint Surg Am. 2007 Apr;89(4):780-5
pubmed: 17403800
J Clin Epidemiol. 2009 May;62(5):511-7.e1
pubmed: 19135859
J Arthroplasty. 2014 May;29(5):929-32
pubmed: 24140271
Diabetes Metab Syndr Obes. 2013 Sep 17;6:327-38
pubmed: 24082791
N Engl J Med. 2002 Aug 1;347(5):305-13
pubmed: 12151467
Open Med. 2007 Apr 14;1(1):e18-26
pubmed: 20101286
Lancet Infect Dis. 2019 Jun;19(6):589-600
pubmed: 31005559
Diabetes Care. 2002 Mar;25(3):512-6
pubmed: 11874939
COPD. 2009 Oct;6(5):388-94
pubmed: 19863368