Operative Time and Risk of Surgical Site Infection and Periprosthetic Joint Infection: A Systematic Review and Meta-Analysis.

Abstract

Background:

The purpose of this study was to perform a systematic review and meta-analysis on the association between operative time and peri-prosthetic joint infection (PJI) after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Methods:

PubMed, Embase, and Cochrane CENTRAL databases were searched for relevant articles dating 2000-2020. Relationship of operative time and PJI rate in primary total joint arthroplasty (TJA) was evaluated by pooled odds ratios (OR) and 95% confidence intervals.

Results:

Six studies were identified for meta-analysis. TJA lasting greater than 120 minutes had greater odds of PJI (OR, 1.63 [1.00-2.66], p=0.048). Similarly, there were greater odds of PJI for TJA procedures lasting greater than 90 minutes (OR, 1.65 [1.27-2.14]; p<0.001). Separate analyses of TKA (OR, 2.01 [0.76-5.30]) and THA (OR, 1.06 [0.80-1.39]) demonstrated no difference in rates of PJI in cases of operative time ≥ 120 minutes versus cases < 120 minutes (p>0.05 for all). Using any surgical site infection (SSI) as an endpoint, both TJA (OR, 1.47 [1.181.83], p<0.001) and TKA (OR, 1.50 [1.08-2.08]; p=0.016) procedures lasting more versus less than 120 minutes demonstrated significantly higher odds of SSI.

Conclusion:

Following TJA, rates of SSI and PJI are significantly greater in procedures ≥120 minutes in duration relative to those < 120 minutes. When analyzing TKA separately, higher rates of SSI were observed in procedures ≥ 120 minutes in duration relative to those <120 minutes. Rates of PJI in TKA or THA procedures alone were not significantly impacted by operative time. Level of Evidence: V.

• Authors: Noah M Scigliano, Christopher N Carender, Natalie A Glass, Jennifer Deberg, Nicholas A Bedard
• Journal: The Iowa orthopaedic journal (Iowa Orthop J) Vol. 42 Issue 1 Pg. 155-161 (06 2022) ISSN: 1555-1377 [Electronic] United States
• PMID: 35821941 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: Copyright © The Iowa Orthopaedic Journal 2022.

Topics

• Arthritis, Infectious
• Humans
• Operative Time
• Prosthesis-Related Infections (etiology)
• Retrospective Studies
• Surgical Wound Infection (etiology)