Factors affecting the duration of antibiotic use due to surgical site inflammation after complication-free classical total knee arthroplasty

Abstract

We researched on the factors affecting the duration of antibiotic use due to surgical site inflammation after complication-free classical total knee arthroplasty (TKA). Four hundred and eighty-nine cases who underwent primary TKA performed by 1 surgeon from January 2015 to December 2018 were enrolled. Including the day of operation, first-generation cephalosporin was injected intravenously for 3 days for antimicrobial prophylaxis. At the third postoperative day, we inspected the surgical wound for any signs of inflammation. If there were any signs of redness, pain, heatness, or swelling, which are the cardinal signs of superficial incisional surgical site infection defined by the Centers of Disease Control (CDC), additional antibiotics were injected until the symptoms of surgical site inflammation improved. We presumed that the duration of antibiotic use was affected by factors including gender, age, body mass index, whether operating on both legs or one leg, predisposing diabetes mellitus, preoperative glomerular filtration rate, preoperative serum albumin level, prior history of anticoagulant usage including anti-platelet agents, allogenic blood transfusion during admission, and total operative time. Average duration of intravenous antibiotic use in 489 cases was 5.73 ± 4.03 days. Pearson correlation analysis showed significant correlation ( P < .01) between operative time and duration of antibiotic use due to surgical site inflammation. In univariate analysis, total operative time and transfusion were factors affecting the duration of antibiotic use due to surgical site inflammation (<6 days or ≥6 days). Multivariate analysis of age, gender, body mass index, staged bilateral TKA, diabetes mellitus, preoperative glomerulus filtration rate, preoperative albumin level, prior history of anticoagulant usage, allogenic blood transfusion during admission, and total operative time revealed that longer operative time was related to higher likelihood of antibiotic use for >6 days during admission. When prophylactic antibiotics are prescribed, surgeons must note that signs of superficial incisional surgical site inflammation after classical complication free TKA may manifest more often in patients with longer operative time.

Effects of Parecoxib Sodium Application Combined with Enhanced Recovery After Surgery Nursing on Inflammatory Factors and Knee Joint Function in Elderly Patients After Total Knee Arthroplasty

“…Severe inflammatory and release of pain-causing substances will occur after TKA, which are the main inducers of postoperative pain in the body ( 19 , 20 ). PS is a new type of non-steroidal anti-inflammatory drug with analgesic, antipyretic, anti-inflammatory, and anti-rheumatic effects.…”

“…Perioperative analgesia can help reduce the inflammatory response caused by TKA, reduce tissue exudation and edema, reduce perioperative hidden and overt bleeding, promote wound healing, and accelerate the functional recovery of the affected knee joint (9)(10)(11). Severe inflammatory and release of pain-causing substances will occur after TKA, which are the main inducers of postoperative pain in the body (19,20). PS is a new type of non-steroidal antiinflammatory drug with analgesic, antipyretic, anti-inflammatory, and anti-rheumatic effects.…”