Impact of operative time on early joint infection and deep vein thrombosis in primary total hip arthroplasty

Wills, Bradley W.; Sheppard, Evan; Smith, Walter R.; Staggers, Jackson; Liu, Mingchun; Shah, Ashish; Lee, S.R.; Naranje, Sameer

doi:10.1016/j.otsr.2018.02.008

Cited by 51 publications

(35 citation statements)

References 19 publications

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“…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).…”

Section: Characteristicssupporting

confidence: 76%

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

Tahmasebi

Vaziri

Vosoughi

et al. 2020

Preprint

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Background: Significant research has been carried out for prevention and also early detection of post-TKA infections. Regarding prevention, utilizing intrawound vancomycin powder in TKA surgery has yielded rather contrasting results in the pertinent literature. Regarding early detection, CDC criteria, although effective in general, are not specifically designed for post-TKA infections. Here, we present a 7-year experience of primary TKA in a high-volume tertiary knee center in Iran, during which intrawound vancomycin powder was used as a routine practice at the end of TKA surgeries. Also, new criteriae are proposed to detect suspected superficial post-TKA infections. Methods: This is a retrospective analysis of primary total knee arthroplasties performed in a tertiary knee center, from March 2011 to December 2018, by a single senior knee surgeon. All patients with follow-up periods of less than one year were excluded from the study. All patient received vancomycin (powder, 1gr) before water-tight closure of the joint capsule. Results: Altogether, 1710 patients were included in the study. Patients were mostly women (male to female ratio: 1 to 4), with a mean age of 64.99 (SD=11.49) years. The overall infection rate was 2.16% (37 of 1710 patients), including 5 periprosthetic deep joint infections and 32 suspected superficial wound infections. Of the 32 suspected superficial infections that were treated with a one-week course of oral antibiotics, all reported disappearance of symptoms, but 2 cases returned with late deep infection. All in all, 7 patients (0.41%) underwent two-stage knee arthroplasty due to deep joint infections. Conclusions: Our experience shows that by utilizing intrawound vancomycin for 7 years as a routine practice along with other measures, we were able to reach relatively low rates of deep post-TKA infections. Howbeit, randomized controlled trials are required to clarify the effect of intrawound vancomycin on post-TKA infection rate.

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Section: Characteristicssupporting

confidence: 76%

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

Tahmasebi

Vaziri

Vosoughi

et al. 2020

Preprint

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“…41 The other previous studies also indicated that prolonged operative time are associated with increased rates of postoperative complications, such as the surgical site infection and delayed wound healing. [42][43][44] In the current study, our results showed that IF has a less operative time than AR. Although Park et al reported that the operative time of IF group is similar with that of AR group, 31 the other 10 included studies reported the similar result with that of meta-analysis.…”

Section: Operative Time Blood Loss and Transfusionsupporting

confidence: 56%

Arthroplasty versus internal fixation for intertrochanteric fractures in the elderly: A meta-analysis

Yu¹,

Lu²,

Xiao³

et al. 2020

Preprint

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Background Surgical treatment is the first choice for intertrochanteric fractures in the elderly as it allows early rehabilitation and functional recovery. Recently, more and more surgeons prefer arthroplasty instead of internal fixation in the treatment of senile intertrochanteric fractures. However, there is conflicting evidence as to which is the best surgical treatment for them. In this article, we performed a systematic review and meta-analysis to compare the clinical effectiveness of internal fixation (IF) and arthroplasty (AR) for intertrochanteric fractures in the elderly. Methods The online databases of PubMed, Cochrane Database, and Web of Science were searched to include studies conducted from 01/01/2000 to 11/30/2018 in English using keywords to identify articles relevant to this study. All studies had to have evaluated the treatment of patients with intertrochanteric fractures in the elderly(≥ 60 years of age). The quality of the trials was assessed and meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.3 version. Results A total of 14 studies involving a total of 1588 patients were suitable for inclusion in this meta-analysis. There was no significant difference between the IF and AR groups for postoperative complications-related general condition (OR = 1.24; 95% CI = 0.90, 1.70; P = 0.19), hospital stay (SMD = 0.16; 95% CI= -0.5, 0.82; P = 0.64), and Harris hip score (SMD= -0.12; 95% CI= -0.79, 0.54; P = 0.71). AR group had a significantly lower rate of complications-related operation (OR = 2.21; 95% CI = 1.41, 3.45; P = 0.0005) and reoperation (OR = 2.74; 95% CI = 1.57, 4.76; P = 0.0004). However, compared with AR group, IF group could reduce the blood loss (OR=-4.08; 95% CI=-4.58, -3.59; P < 0.00001), transfusion requirement (SMD= -0.67; 95% CI= -1.08, -0.26; P = 0.001), operation time (SMD= -0.80; 95% CI= -1.47, -0.12; P < 0.00001), and have a lower rate of mortality within 1-year (OR = 0.67; 95% CI = 0.52, 0.86; P = 0.002). Conclusion AR is associated with less rates of complications-related operation and reoperation but has an increased risk of blood loss, transfusion, operation time and mortality within 1-year. Our findings demonstrated that AR does not have significant advantages over IF for intertrochanteric fractures in the elderly.

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“…Operative times have historically been identified as an important factor in postoperative outcomes for TKA. Increasing operative times are associated with worse outcomes, such as increased rates of infections, thromboemboli, neurologic deficits, revisions, and other complications (3)(4)(5)(6)(7)(8)(9)(10). Young et al analyzed 61,438 TKAs in the New Zealand Joint Registry over a 13-year period and found increasing revision rates with operative times longer than 120 minutes (P<0.01) (10).…”

Section: Introductionmentioning

confidence: 99%

The effect of operative time on in-hospital length of stay in revision total knee arthroplasty

Garbarino¹,

Gold²,

Sodhi³

et al. 2019

Ann. Transl. Med

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Background: Revision total knee arthroplasty (TKA) is associated with increased rates of infections, readmissions, longer operative times, and lengths-of-stay (LOS) compared to primary TKA. Additionally, increasing operative times and prolonged postoperative LOS are independent risk factors for these postoperative complications in lower extremity total joint arthroplasty (TJA). This has led to an increased effort to reduce these risk factors in order to improve patient outcomes and reduce cost. However, the relationship between operative time and LOS has not been well assessed in revision arthroplasty. Therefore, the purpose of this study was to: (I) identify predictors of longer operative times; (II) identify predictors of longer LOS; and (III) evaluate the effects of operative time, treated as both a categorical variable and a continuous variable, on LOS after revision TKA. Methods: The NSQIP database was queried for all revision TKA cases (CPT code 27487) between 2008 and 2016 which yielded 10,604 cases. Mean operative times were compared between patient demographics including age groups, sex, and body mass indexes (BMIs). To determine predictors of LOS, mean LOS were also compared between patient demographics in the same groups. To assess the correlation of operative time on LOS, the mean LOS for 30-minute operative time intervals were compared. Univariate analysis was performed with one-way analysis of variance (ANOVA) and t-tests. A multivariate analysis with a multiple linear regression model was performed to evaluate the association of LOS with operative times after adjusting for patient age, sex, and BMI. Results: The mean LOS for revision TKA was 4 (±3) days. Further analysis showed that young age is associated with increased LOS (P<0.01). An analysis of operative times showed positive correlations with young age, BMI greater than 30 and male sex (P<0.05). The mean LOS of revision TKA patients was found to increase with increasing operative time in 30-minute intervals (P<0.001). Multivariate analysis showed that longer operative times had significant associations with longer LOS even after adjusting for patient factors (β=0.102, SE =0.001, P<0.001). These results also showed that out of all of the study covariates, operative times had the greatest effect on LOS after revision TKA. Conclusions: Revision TKA is a complex procedure, often requiring increased operative times compared to primary TKA. This study provides unique insight by correlating operative times to LOS in over 10,000 revision TKAs from a nationwide database. Our results demonstrate that out of all the study covariates (age, sex, and BMI), operative times had the greatest effect on LOS. The results from this study indicate that less time spent in the operating room can lead to shorter LOS for revision TKA patients. This relationship further underscores the need for improved preoperative planning and intra-operative efficiency in an effort to decrease LOS and improve patient outcomes.

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Impact of operative time on early joint infection and deep vein thrombosis in primary total hip arthroplasty

Abstract: III.

Cited by 51 publications

References 19 publications

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

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

Arthroplasty versus internal fixation for intertrochanteric fractures in the elderly: A meta-analysis

The effect of operative time on in-hospital length of stay in revision total knee arthroplasty

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