Risk Factors Associated with Deep Surgical Site Infections After Primary Total Knee Arthroplasty

Namba, Robert S.; Inacio, Maria C.S.; Paxton, Elizabeth W.

doi:10.2106/jbjs.l.00211

Cited by 523 publications

(402 citation statements)

References 17 publications

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“…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%

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

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%

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

160

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“…Prior studies have suggested that patients with DM undergoing TKA have a higher likelihood of wound complications and surgical site infections than those without DM [5,6,8,18,20,21,28]. Hence, achieving optimal glycemic control in patients with DM is important.…”

Section: Discussionmentioning

confidence: 99%

“…Diabetes mellitus (DM) is one of the most common and important diseases thought to be associated with an increased risk of perioperative complications among patients undergoing TKA. Previous studies have reported higher rates of infection [8,18,20,21,28], wound complications [5,6], greater risk of deep vein thrombosis [27,29], poorer outcomes [4,13,14,22,25], and higher mortality [2] in patients with DM undergoing TKA compared with patients without DM. Unfortunately, the prevalence of DM among patients undergoing TKA has been steadily increasing [11,15] and orthopaedic surgeons will be faced with a growing number of surgical patients with DM.…”

Section: Introductionmentioning

confidence: 99%

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Hwang

Kim

Bamne

et al. 2015

Clinical Orthopaedics &Amp; Related Research

109

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Background Patients with diabetes have increased risk of infections and wound complications after total knee arthroplasty (TKA). Glycemic markers identifying patients at risk for complications after TKA have not yet been elucidated. Questions/purposes We aimed to determine the correlations among four commonly used glycemic markers and to identify the glycemic markers most strongly associated with the occurrence of surgical site infections and postoperative wound complications in patients with diabetes mellitus after undergoing TKA. Methods Our retrospective study included 462 patients with diabetes, who underwent a total of 714 TKAs. Blood levels of glycemic markers, including preoperative fasting blood glucose (FBG), postprandial glucose (PPG2), glycated hemoglobin (HbA 1c ), and levels obtained from random glucose testing on postoperative days 2, 5, and 14, were collected on all patients as part of a medical clearance program and an established clinical pathway for patients with diabetes at our center. Complete followup was available on 93% (462 of 495) of the patients. Correlations among markers were assessed. Associations between the markers and patient development of complications were analyzed using multivariate regression analyses of relevant cutoff values. We considered any of the following as complications potentially related to diabetes, and these were considered study endpoints: surgical site infection (superficial and deep) and wound complications (drainage, hemarthrosis, skin necrosis, and dehiscence). During the period of study, there were no fixed criteria applied to what levels of glycemic control patients with diabetes needed to achieve before undergoing arthroplasty, and there were wide ranges in the levels of all glycemic markers; for example, whereas the mean HbA 1c level was 7%, the range was 5% to 11.3%.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained. This work was performed at the Joint Reconstruction Center, Seoul National University Bundang Hospital, Seoul, Republic of Korea. Results There were positive correlations among the levels of the four glycemic markers; the strongest correlation was found between the preoperative HbA 1c and PPG2 levels (R = 0.502, p \ 0.001). After controlling for potential confounding variables using multivariate analysis, the HbA 1c cutoff level of 8 (odds ratio [OR], 6.1; 95% confidence interval...

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“…Wound contamination at the time of the procedure is thought to be a cause of early postoperative infections [10,13,17,18]. Recent studies have shown increased wound contamination and infection rates with the use of modern surgical helmet systems compared with conventional gowns, and it has been hypothesized that the positive pressure within a surgical helmet system may potentially underlie the higher rates of wound contamination and infection [7,11,12,18]. The purpose of our study was to determine the amount of particle contamination at the gown-glove interface in several modern surgical helmet systems as well as conventional gowns.…”

Section: Discussionmentioning

confidence: 99%

The Gown-glove Interface Is a Source of Contamination: A Comparative Study

Fraser

Young

Valentine

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background The original Charnley-type negative-pressure body exhaust suit reduced infection rates in randomized trials of total joint arthroplasty (TJA) decades ago. However, modern positive-pressure surgical helmet systems have not shown similar benefit, and several recent studies have raised the question of whether these gowning systems result in increased wound contamination and infections. The gown-glove interface may be one source of particle contamination.Questions/purposes The purpose of this study was to compare particle contamination at the gown-glove interface in several modern surgical helmet systems and conventional surgical gowns. Methods A 5-lm fluorescent powder was evenly applied to both hands to the level of the wrist flexion crease. After gowning in the standard fashion, the acting surgeon performed a 20-minute simulated TJA protocol. Each of the five gowning systems was run through five trials. The amount of gown contamination at the gown-glove interface then was measured by three observers under ultraviolet light using a grading scale from 0 (no contamination) to 4 (gross contamination). Statistical analysis was carried out with Minitab 15. Friedman's test was used to compare the levels of contamination across trials for each gown and the Mann-Whitney test was used post hoc to perform a pairwise comparison of each gown. Results All gown-glove interfaces showed some contamination. Friedman's test showed that there was a significant difference in contamination between gowns (p = 0.029). The Stryker T5 Zipper Toga system showed more contamination than the other gowns. The median contamination score and range for each gowning setup was 1.8 (range, 1-4; conventional Kimberly-Clark MicroCool gown without helmet), 4 (range, 3-4; Stryker T5 Zipper Toga), 3.6 (range, 0-4; Stryker helmet with conventional gown), 1.6 (range, 0-2; Stryker Flyte Toga), and 3.0 (range, 2-3; DePuy Toga). A Mann-Whitney test found no difference among any of the gowns except for the Stryker T5 Zipper Toga, which showed more contamination

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Risk Factors Associated with Deep Surgical Site Infections After Primary Total Knee Arthroplasty

Abstract: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 523 publications

References 17 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

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

The Gown-glove Interface Is a Source of Contamination: A Comparative Study

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