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

Published online by Cambridge University Press:  22 September 2015

Kristen V. Dicks*
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
Arthur W. Baker
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
Michael J. Durkin
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
Deverick J. Anderson
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
Rebekah W. Moehring
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Durham Veterans Affairs Medical Center, Durham, North Carolina
Luke F. Chen
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
David J. Weber
Affiliation:
Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
Sarah S. Lewis
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
*
Address correspondence to Kristen V. Dicks, MD, PO Box 102359, Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, NC 27710 (kristen.dicks@duke.edu)

Abstract

OBJECTIVE

To 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.

DESIGN

Retrospective cohort study

SETTING

A total of 43 community hospitals located in the southeastern United States.

PATIENTS

Adults 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.

METHODS

Log-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.

RESULTS

A 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).

CONCLUSIONS

Short 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

Type
Original Articles
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care–associated infections. N Engl J Med 2014;370:11981208.CrossRefGoogle ScholarPubMed
2. Umscheid, CA, Mitchell, MD, Doshi, JA, Agarwal, R, Williams, K, Brennan, PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011;32:101114.CrossRefGoogle ScholarPubMed
3. Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999;27:97132.CrossRefGoogle ScholarPubMed
4. Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991;91:152S157S.CrossRefGoogle ScholarPubMed
5 Ridgeway, S, Wilson, J, Charlet, A, Kafatos, G, Pearson, A, Coello, R. Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br 2005;87:844850.CrossRefGoogle ScholarPubMed
6. Leong, G, Wilson, J, Charlett, A. Duration of operation as a risk factor for surgical site infection: comparison of English and US data. J Hosp Infect 2006;63:255262.CrossRefGoogle ScholarPubMed
7. Peersman, G, Laskin, R, Davis, J, Peterson, MGE, Richart, T. Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J 2006;2:7072.CrossRefGoogle ScholarPubMed
8. Campbell, DA, Henderson, WG, Englesbe, MJ, et al. Surgical site infection prevention: the importance of operative duration and blood transfusion—results of the First American College of Surgeons National Surgical Quality Improvement Program Best Practices Initiative. J Am Coll Surg 2008;207:810820.CrossRefGoogle ScholarPubMed
9. Urquhart, DM, Hanna, FS, Brennan, SL, et al. Incidence and risk factors for deep surgical site infection after primary total hip arthropalsty: a systematic review. J Arthroplasty 2010;25:12161222.CrossRefGoogle Scholar
10. Willis-Owen, CA, Konyves, A, Martin, DK. Factors affecting the incidence of infection in hip and knee replacement: an analysis of 5277 cases. J Bone Joint Surg Br 2010;92:11281133.CrossRefGoogle ScholarPubMed
11. Namba, RS, Inacio, MC, Paxton, EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am 2013;95:775782.CrossRefGoogle Scholar
12. Anderson, DJ, Miller, BA, Chen, LF, et al. The network approach for prevention of healthcare-associated infections: long-term effect of participation in the Duke Infection Control Outreach Network. Infect Control Hosp Epidemiol 2011;32:315322.CrossRefGoogle Scholar
13. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309332.CrossRefGoogle ScholarPubMed
14. Katz, JN, Losina, E, Barrett, J, et al. Association between hospital and surgical procedure volume and outcomes of total hip replacement in the United States medicare population. J Bone Joint Surg Am 2001;83:16221629.CrossRefGoogle ScholarPubMed
15. Katz, JN, Barrett, J, Mahomed, NN, Baron, JA, Wright, RJ, Losina, E. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am 2004;86:19091916.CrossRefGoogle ScholarPubMed
16. Muilwijk, J, van den Hof, S, Wille, JC. Associations between surgical site infection risk and hospital operation volume and surgeon operation volume among hospitals in the dutch nosocomial infection surveillance network. Infect Control Hosp Epidemiol 2007;28:557563.CrossRefGoogle ScholarPubMed
17. Lau, RL, Perruccio, AV, Gandhi, R, Mahomed, NN. The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literature. BMC Musculoskelet Disord 2012;13:250260.CrossRefGoogle ScholarPubMed