Retrospective study of factors associated with surgical site infection in dogs following tibial plateau leveling osteotomy

López, D.; VanDeventer, Gretchen M.; Krotscheck, Ursula; Aryazand, Yazdan; McConkey, Marina J.; Hayashi, Kei; Todhunter, Rory J.; Hayes, Galina

doi:10.2460/javma.253.3.315

Cited by 26 publications

(36 citation statements)

References 34 publications

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“…Increased anaesthetic duration, surgical time, method of skin closure, meniscectomy and surgeon experience have been significantly associated with SSI in previous veterinary orthopaedic studies [16][17][18][19][20][21][22] but none of these variables were found to be significantly associated with development of SSI in ours and previous studies. 14,21,33,49 Human CDC guidelines for classification of SSI have recently been updated to include infections developing up to 90 days after surgery where an implant is used. 23 No veterinary-specific guidelines are established and therefore veterinary literature often cites previous CDC guidelines for SSI investigations.…”

Section: Discussionmentioning

confidence: 99%

“…9,[11][12][13] Surgical site infection (SSI) rates following surgical management of cranial cruciate ligament rupture range from 3 to 26%. [14][15][16][17][18][19][20][21][22] Two previous studies examining arthrotomy and lateral fabellotibial suture for the management of cranial cruciate ligament rupture reported infection rates of 3.9 to 4.2%. 12,20 Meniscectomy, surgeon experience, breed, postoperative antibiotic medications, implant selection, anaesthetic and surgical times, bodyweight and use of skin staples have all been implicated as risk factors for SSI following stifle surgery in dogs.…”

Section: Introductionmentioning

confidence: 99%

“…12,20 Meniscectomy, surgeon experience, breed, postoperative antibiotic medications, implant selection, anaesthetic and surgical times, bodyweight and use of skin staples have all been implicated as risk factors for SSI following stifle surgery in dogs. 14,[16][17][18][19][20][21] The United States Centres for Disease Control and Prevention (CDC) guidelines for classifying SSI have recently been updated to include infections developing up to 90 days after surgery where an implant is used. 23 The CDC guidelines are published for use in human specific surgeries; however, these guidelines are often adapted for veterinary SSI investigations.…”

Section: Introductionmentioning

confidence: 99%

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Investigation of Variables Associated with Surgical Site Infection following the Management of Canine Cranial Cruciate Ligament Rupture with a Lateral Fabellotibial Suture

Cox

Maddox²,

Pettitt

et al. 2020

Vet Comp Orthop Traumatol

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Objectives This study investigated variables associated with surgical site infection (SSI) in dogs with cranial cruciate ligament rupture managed with stifle joint examination and lateral fabellotibial suture stabilization. Study Design A retrospective study of dogs that had stifle arthroscopy, stifle arthrotomy, or a combination of both, followed by lateral fabellotibial suture stabilization for cranial cruciate ligament rupture. All cases had a minimum follow-up of 90 days. Lameness grades were recorded preoperatively, and at 6-week and final follow-up. Results One hundred fifty procedures in 130 dogs met the inclusion criteria. Overall, SSI rate was 17.3% and removal of the lateral fabellotibial suture was performed in 53% of SSI. Multivariable analysis showed significant association between SSI and bodyweight (p = 0.013), and induction using propofol (p = 0.029). Multilevel ordinal logistic regression analysis showed a greater proportion of dogs had a higher lameness grade at 6-week (p = 0.021) and final follow-up (p = 0.002) assessments in the infected compared with non-infected dogs. Conclusion Our study demonstrated a higher SSI incidence than previously reported in dogs undergoing a lateral fabellotibial suture for cranial cruciate ligament rupture. Bodyweight and induction with propofol were identified as significant risk factors for postoperative SSI. Owners could be advised of an increased SSI risk in larger dogs and consideration should be given to selection of induction agent. Dogs that develop an SSI have a worse lameness grade at 6-week and final follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Investigation of Variables Associated with Surgical Site Infection following the Management of Canine Cranial Cruciate Ligament Rupture with a Lateral Fabellotibial Suture

Cox

Maddox²,

Pettitt

et al. 2020

Vet Comp Orthop Traumatol

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“…7 The remaining 69% (9/13) of studies provided data on postoperative antibiotic use as a secondary outcome measurement (Table 1B). 6,[9][10][11][22][23][24]28,29 All studies were retrospective, with mOLE classification of either 4b or 4c. These studies provided evaluation of 3227 TPLO procedures, and publication years ranged from 2010 to 2019.…”

Section: Manuscript Reviewmentioning

confidence: 99%

Efficacy of postoperative antibiotic use after tibial plateau leveling osteotomy in dogs: A systematic review

2021

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Objective: A systematic review of published data to determine whether postoperative antibiotic use after tibial plateau leveling osteotomy (TPLO) decreases infection rates. Study design: Systematic review.Methods: A broad bibliographic search was performed in three online databases through March 2020 for publications on postoperative antibiotic use after TPLO in dogs. Search terms included dog, canine, TPLO, tibial plateau leveling osteotomy, infection, antibiotic, and antimicrobial. Articles that met inclusion criteria were evaluated for level of evidence (LoE) by a modified Oxford Level of Evidence (mOLE) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) classification and evaluation.Results: Thirteen studies met the inclusion criteria. Effect of antibiotic use was the primary question in four studies. Among those, 50% (2/4) were assigned a mOLE of 1b and a GRADE of moderate, while the other 50% (2/4) were assigned a mOLE of 4b or 4c with a GRADE of low. The two studies with the highest LoE did not provide evidence of the benefit of antibiotic usage.Results of only one study provided evidence to support the use of postoperative antibiotics. The remaining nine studies provided evaluation of antibiotic use secondarily and were all assigned a low LoE. Among these, 78% (7/9) provided evidence to support the use of postoperative antibiotics. Conclusion:We found little evidence to support the use of postoperative antibiotics to reduce the risk of surgical site infections in dogs after TPLO. The answer to this clinical question is complicated by the lack of prospective studies and inconsistent treatment protocols in the evaluated studies.Clinical significance: The clinical impact of postoperative antibiotic administration on infection rates after TPLO is uncertain.

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“…Contradictory findings, however, have been reported. Several reports of recent studies involving dogs undergoing TPLO have described a reduced risk of postoperative infection with the use of postoperative antibiotic therapy, while other reports have described findings that postoperative antibiotic therapy did not result in a significant reduction in SSI . However, the only two studies in which dogs weighing >50 kg were assessed provided evidence of a protective effect of the use of postoperative antimicrobial treatment .…”

Section: Discussionmentioning

confidence: 99%

Risk of infection after double locking plate and screw fixation of tibial plateau leveling osteotomies in dogs weighing greater than 50 kilograms

Tuan¹,

Solano²,

Danielski

2019

Veterinary Surgery

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Objective To compare surgical site infection (SSI) rates after double locking plate and screw fixation (DLP), standard locking plate and screw fixation (LP), and conventional nonlocking plate and screw fixation (NLP) in dogs weighing >50 kg undergoing tibial plateau leveling osteotomy (TPLO). Study design Retrospective study (January 2003‐October 2017). Animals Two hundred seventy‐five dogs weighing >50 kg with cranial cruciate ligament disease treated with TPLO. Methods Medical records of dogs weighing >50 kg that underwent TPLO by DLP, LP, and NLP with a minimum follow‐up period of 12 months were included. Data collected included signalment, details of any concurrent surgical procedure, type of implant used, use of postoperative antibiotic therapy, occurrence of perioperative complications, and presence of postoperative infection. The probability, risk difference, and relative risk of SSI were estimated for each fixation with a marginal model. Results Nonlocking plate and screw fixation was used in 114 (41.5%) dogs, LP was used in 128 (46.5%) dogs, and DLP was used in 33 (12%) dogs. Surgical site infection was diagnosed in 48 of 275 (17.5%) dogs. Postoperative antibiotic therapy was used in 74 (64.9%) dogs, 62 (48.4%) dogs, and 32 (97.0%) dogs in the NLP, LP, and DLP groups, respectively. Dogs with NLP, LP, and DLP had postoperative infection rates of 24.5%, 13.3%, and 9.1%, respectively. There were no risk differences for the three groups (Holm‐adjusted P > .05). Conclusion No difference in infection rates was detected between DLP, LP, or NLP for TPLO in these dogs weighing >50 kg. Clinical significance Fixation of TPLO with DLP in dogs weighing >50 kg does not seem to increase the risk of SSI compared with LP and NLP.

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Retrospective study of factors associated with surgical site infection in dogs following tibial plateau leveling osteotomy

Cited by 26 publications

References 34 publications

Investigation of Variables Associated with Surgical Site Infection following the Management of Canine Cranial Cruciate Ligament Rupture with a Lateral Fabellotibial Suture

Investigation of Variables Associated with Surgical Site Infection following the Management of Canine Cranial Cruciate Ligament Rupture with a Lateral Fabellotibial Suture

Efficacy of postoperative antibiotic use after tibial plateau leveling osteotomy in dogs: A systematic review

Risk of infection after double locking plate and screw fixation of tibial plateau leveling osteotomies in dogs weighing greater than 50 kilograms

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