Does Operative Time Affect Infection Rate in Primary Total Knee Arthroplasty?

Abstract

Background Prolonged operative time may increase the risk of infection after total knee arthroplasty (TKA). Both surgeon-related and patient-related factors can contribute to increased operative times. Questions/purposes The purpose of this study was to determine (1) whether increased operative time is an independent risk factor for revision resulting from infection after TKA; (2) whether increasing body mass index (BMI) increased operative time; and (3) whether increasing experience substantially decreased operative time. Methods We retrospectively evaluated primary TKAs from our joint registry between March 2000 and August 2012. Cox proportional hazard models were used to assess the relationship between operative time and revision resulting from infection after accounting for age, sex, BMI, and Agency for Healthcare Research and Quality comorbidity score. Of 9973 instances of primary TKA, 73 underwent revision surgery for infection (0.73%). Results After accounting for the confounders of age and sex, operative time was not found to have a significant effect; a 15-minute increase in operative time increased the hazard of revision resulting from infection by only 15.6% (p = 0.053; 95% confidence interval, 0.0%-34.0%). In addition, a five-unit increase in BMI was found to increase mean operative time by 1.9 minutes, on average, regardless of sex (p \ 0.0001). Operative time decreases with increasing experience but appears to plateau at approximately 300 surgeries. Conclusions Operative time is only one of many factors that may increase infection risk and may be influenced by numerous confounders. Increasing BMI increased operative time but the effect was modest. The effect of increasing experience on operative duration of this common procedure was surprisingly limited among our surgeons. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Low Post-Arthroplasty Infection Rate is Possible in Developing Countries: Long-Term Experience of Local Vancomycin Use From A High-Volume Tertiary Knee Center in Iran

“…Previously it has been proved that increased operative time could result in higher complication rate especially infection, venous thromboembolism (VTE) and patient dissatisfaction (24,(26)(27)(28)(29)(30)(31). Each TKA surgery in this study took an average of 60.30 minutes (SD = 44.19) from incision to wound dressing, which is comparable to other reports (27,32).…”

Obesity Is Associated with Significant Morbidity after Multiligament Knee Surgery

“…Surgical times may be longer secondary to increased dissection time and technical difficulties with maneuvering a heavier knee. This may not only increase the risk of patient complications due to contamination and infection, 27,28 or adverse cardiovascular, genitourinary, pulmonary events, 29,30 but also poses a significant economic burden for hospitals. 31 At the institution in which this investigation was performed, for example, a minute in the operating room costs approximately $112.…”

Postoperative Complications Causing Readmission in 30 Days after Total Knee Arthroplasty: A Retrospective Nested Case-Control Study of Risk Factors Based on Propensity Score Matching

“…Considering few investigators have primarily studied the association between operative time with 30-day morbidity and mortality after TKA, while controlling for confounding variables including age, sex, BMI, and procedure description based on PSM methods, [34][35][36] we investigated the effect of operative duration using a stratified approach to evaluate their prediction effect. For this purpose, we brought a sizable sample into our research and also offered the description of nonlinear correlation between operative duration and complications.…”