Operating Room Ventilation With Laminar Airflow Shows No Protective Effect on the Surgical Site Infection Rate in Orthopedic and Abdominal Surgery

Brandt, Christian; Hott, Uwe; Sohr, Dorit; Daschner, Franz; Gastmeier, Petra; Rüden, H.

doi:10.1097/sla.0b013e31818b757d

Cited by 222 publications

(155 citation statements)

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“…Most investigators described the ventilation system used in the control group as "conventional (plenum)" or "ordinary" ventilation system, 30,32,36,39,40 while others reported the use of "conventional turbulent ventilation with HEPA-filtered air". 31,37,38 In four studies, investigating THA 34 and TKA 35,41 performed in the USA between 2000 and 2009 and gastric surgery 33 performed in the Republic of Korea between 2010 and 2011, the authors did not provide additional information about the ventilation system of the ORs without LAF. These studies were included after discussion.…”

Section: Resultsmentioning

confidence: 99%

“…Two studies assessed the overall (superficial and deep) SSI rate as well. 31,37 We considered deep SSI as the critical outcome for further analysis. Brandt and colleagues reported on overall and deep SSI for abdominal surgery.…”

Section: Resultsmentioning

confidence: 99%

“…After removal of duplicates and screening, 109 articles were assessed for eligibility. Finally, 12 observational cohort studies [30][31][32][33][34][35][36][37][38][39][40][41] comparing LAF with conventional ventilation in the OR were identified. Most investigators described the ventilation system used in the control group as "conventional (plenum)" or "ordinary" ventilation system, 30,32,36,39,40 while others reported the use of "conventional turbulent ventilation with HEPA-filtered air".…”

Section: Resultsmentioning

confidence: 99%

“…One small study on hemiarthroplasty of the hip was included with studies on THA because the procedures are similar. 40 Single studies were identified for abdominal and open vascular surgery 30,31,33 (table 2). All studies on THA and TKA investigated deep SSI.…”

Section: Resultsmentioning

confidence: 99%

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Effect of laminar airflow ventilation on surgical site infections: a systematic review and meta-analysis

Bischoff

Kubilay

Allegranzi

et al. 2017

The Lancet Infectious Diseases

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160

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Background: The role of the operating room's (OR) ventilation system in the prevention of surgical site infection (SSI) is widely discussed and the existing guidelines do not reflect the current evidence. In this context, laminar airflow (LAF) ventilation was compared with conventional ventilation to assess their effectiveness in reducing the risk of SSI.Methods: Medline, EMBASE, Cochrane Central Register of Controlled Trials and WHO regional medical databases were searched from 1990 to 31 January 2014. The search was updated for Medline for the time period between 1 February 2014 and 27 May 2016. GRADE methodology was used to assess the quality of the retrieved evidence. Meta-analyses of available comparisons were performed using RevMan 5.3. Findings: The search identified 1947 records of which 12 observational studies were identified comparing LAF ventilation with conventional turbulent ventilation in orthopedic, abdominal, and vascular surgery. The meta-analysis of eight cohort studies showed no difference in risk for deep SSIs following total hip arthroplasty (THA, 330 146 procedures; odds ratio (OR) 1·29, 95% CI 0·98-1·71, p=0·07; I²=83%). For total knee arthroplasty (TKA, 134 368 procedures) the meta-analysis of six cohort studies showed no difference in risk for deep SSIs (OR 1·08, 95% CI 0·77-1·52, p=0·65; I²=71%). For abdominal and open vascular surgery the metaanalysis of three cohort studies found no difference in risk for overall SSI (OR 0·75, 95% CI 0·43-1·33, p=0·33; I²=95%) Interpretation: The available evidence shows no benefit for LAF compared with conventional turbulent OR ventilation in reducing the risk of SSI in THA, TKA and abdominal surgery. Decision makers, medical and administrative, should not choose to install and use LAF equipped ORs as a preventive measure to reduce the risk of SSI. AbstractBackground: The role of the operating room's (OR) ventilation system in the prevention of surgical site infection (SSI) is widely discussed and the existing guidelines do not reflect the current evidence. In this context, laminar airflow (LAF) ventilation was compared with conventional ventilation to assess their effectiveness in reducing the risk of SSI.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Effect of laminar airflow ventilation on surgical site infections: a systematic review and meta-analysis

Bischoff

Kubilay

Allegranzi

et al. 2017

The Lancet Infectious Diseases

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160

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“…More recent studies have continued to show the importance of laminar flow in lowering postoperative SSIs 10 . However, other studies suggest that laminar flow makes little difference to rates of SSIs 19,20 or that it may even increase rates of infection 21 . Despite this, theatres are generally all laminar flow as standard in newly built hospitals.…”

Section: Discussionmentioning

confidence: 99%

Laminar flow reduces cases of surgical site infections in vascular patients

Bosanquet

Jones

Gill

et al. 2013

annals

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IntroductionNumerous strategies are employed routinely in an effort to lower rates of surgical site infections (SSIs). A laminar flow theatre environment is generally used during orthopaedic surgery to reduce rates of SSIs. Its role in vascular surgery, especially when arterial bypass grafts are used, is unknown.MethodsA retrospective review of a prospectively maintained database was undertaken for all vascular procedures performed by a single consultant over a one-year period. Cases were performed, via random allocation, in either a laminar or non-laminar flow theatre environment. Demographic data, operative data and evidence of postoperative SSIs were noted. A separate subgroup analysis was undertaken for patients requiring an arterial bypass graft. Univariate and multivariate logistical regression was undertaken to identify significant factors associated with SSIs.ResultsOverall, 170 procedures were analysed. Presence of a groin incision, insertion of an arterial graft and a non-laminar flow theatre were shown to be predictive of SSIs in this cohort. In the subgroup receiving arterial grafts, only a non-laminar flow theatre environment was shown to be predictive of an SSI.ConclusionsThis study suggests that laminar flow may reduce incidences of SSI, especially in the subgroup of patients receiving arterial grafts.

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Association of Laminar Airflow During Primary Total Joint Arthroplasty With Periprosthetic Joint Infection

Wang

Goswami

et al. 2020

JAMA Netw Open

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IMPORTANCE Whether laminar airflow (LAF) in the operating room is effective for decreasing periprosthetic joint infection (PJI) after total joint arthroplasty remains a clinically important yet controversial issue. OBJECTIVE To investigate the association between operating room LAF ventilation systems and the risk of PJI in patients undergoing total joint arthroplasty. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted of 6972 consecutive patients undergoing primary total knee arthroplasty or total hip arthroplasty at 2 surgical facilities within a single institution from January 1, 2013, to September 15, 2017, with a minimum of 1 year of follow-up. All procedures were performed by 5 board-certified arthroplasty surgeons.

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Operating Room Ventilation With Laminar Airflow Shows No Protective Effect on the Surgical Site Infection Rate in Orthopedic and Abdominal Surgery

Abstract: Unexpectedly, in this analysis, which controlled for many patient and hospital-based confounders, OR ventilation with laminar airflow showed no benefit and was even associated with a significantly higher risk for severe SSI after hip prosthesis.

Cited by 222 publications

References 23 publications

Effect of laminar airflow ventilation on surgical site infections: a systematic review and meta-analysis

Effect of laminar airflow ventilation on surgical site infections: a systematic review and meta-analysis

Laminar flow reduces cases of surgical site infections in vascular patients

Association of Laminar Airflow During Primary Total Joint Arthroplasty With Periprosthetic Joint Infection

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