Is Arthroplasty Immediately After an Infected Case a Risk Factor for Infection?

Abstract

Background It is common practice in many centers to avoid performing a clean case in a room in which an infected procedure has just taken place. No studies of which we are aware speak to the necessity of this precaution. Questions/purposes The purposes of this study were to identify (1) the risk of infection in a group of patients who underwent arthroplasties performed immediately after a first-stage arthroplasty for joint infection; and (2) the risk of superficial and deep infections in these patients compared with a matched group of patients who underwent arthroplasties not performed after an infected surgery. Methods Eighty-three patients (85 arthroplasties) who underwent arthroplasties (primary or revision) immediately after patients with known infections underwent surgery in the same operating room (OR) were analyzed for 12 months after surgery to determine the incidence of infection. They were matched for demographic factors and surgery type with a control group of 321 patients (354 arthroplasties) who underwent surgery in an OR that had not just been used for surgery involving patients with infections. We compared the risk of superficial and deep infections between the groups. Results Patients in the study group were not more likely to have infections develop than those in the control group. One patient in the study group (1.17%) and three in the control group (0.84%) had deep infections develop; the infection in the patient in the study group was caused by a different organism than that of the patient with an infection whose surgery preceded in the OR. Two superficial infections (2.35%) were detected in the study group and 17 (4.8%) were detected in the control group. Conclusions With the numbers available, we found that a deep infection was not more likely to occur in a patient without an infection after an arthroplasty that followed surgery on a patient with an infection than in one who had surgery after a clean case. Although sample size was a potential issue in this study, the results may serve as hypothesis generating for future studies. Level of Evidence Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Effect of Surgical Start Time on Stapedotomy Outcomes

“…Later cases may carry additional risk for infection if the preceding cases were dirty (e.g., infected cholesteatoma or abscess) or if surgical equipment is flash sterilized between cases. This has been evaluated in orthopedic surgery, where the rates of arthroplasty infection were not significantly higher when the preceding case involved a known infection (16). We similarly found no significant difference in infection rates between start time groups; however, we did not control for the wound class of the preceding case in the later start group.…”

Perioperative Medical Management for Total Joint Arthroplasty

“…showed that the infection rate did not increase in 85 primary and revision JRs performed immediately after a resection arthroplasty for infection in the same operating room (Abolghasemian et al 2013 ). When possible, though evidence is lacking, contaminated cases should be held until all of the clean cases have been performed in that room for the day.…”

Reducing periprosthetic joint infection: what really counts?

“…they identified operating room traffic as the main concern during tJA: opening the operating room door disrupts the LAF, allowing pathogens to enter the space surrounding the surgical site. in order to mitigate this problem, careful planning and anticipation of instrument and implant needs is essential; proper education of operating room staff regarding the function of the LAF system and the relationship between traffic and infection may also increase awareness (67)(68)(69). Although recent research (68) did not show a higher incidence of PJi when an arthroplasty was performed in an operating room just used for surgery on a patient with infection, the study may have been biased by the small sample size; therefore, until further studies are conducted, we prefer to avoid performing a clean case, such as a tJR, in a room in which an infected procedure has just taken place, and indeed recommend that this practice be avoided.…”