Risk factors associated with surgical site infection in 30 491 primary total hip replacements

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

doi:10.1302/0301-620x.94b10.29184

Cited by 208 publications

(144 citation statements)

References 29 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%

“…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%

“…We identified eight observational studies 31,32,34,[36][37][38][39][40] comparing the association of LAF ventilation and conventional ventilation on the deep SSI rate after THA. Three large multicentre studies based on data obtained from national joint registries and surveillance systems found that LAF was associated with a higher risk of deep SSI 31 and revision due to infection, 32,39 whereas one small single centre study found LAF to be associated with a decreased risk of revision due to infection.…”

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

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%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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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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“…Additionally, the extent of postsurgical inflammatory reaction correlates with the severity of pain experienced by patients after total joint arthroplasty [15]. Obesity has recently been found to be an independent risk factor for severity of postoperative pain after musculoskeletal surgery and for risk of surgical site infection after THA [21,23]. Although the exact underlying mechanisms remain obscure, some of the consequences and complications of obesity likely are caused by the condition.…”

Section: Introductionmentioning

confidence: 99%

Association of Obesity With Inflammation and Pain After Total Hip Arthroplasty

Motaghedi

Bae

Memtsoudis

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The prevalence of obesity is increasing, and obesity often leads to degenerative joint disease requiring total hip arthroplasty (THA). Obesity is a proinflammatory state associated with an increase in chronic, low-grade inflammatory response. As such, it may augment the postoperative inflammatory response, which has been associated with postoperative pain and complications.Questions/purposes We determined whether severity of obesity was associated with (1) severity of inflammatory response, as measured by the in vivo circulating levels of cytokines and ex vivo functional reactivity of mononuclear blood cells, and (2) severity of pain, as measured by verbal pain scores and analgesic consumption, in the first 24 hours after THA. Methods We studied 60 patients (20 normal weight, 20 overweight, 20 obese) undergoing elective primary unilateral THA in this prospective cross-sectional study. Blood samples were collected for C-reactive protein and cytokine levels, including IL-1b, IL-2, IL-6, IL-8, and tumor necrosis factor a (TNF-a), from patients before and 24 hours after surgery. Cytokine response of whole blood was evaluated ex vivo with or without two standard activators, phorbol-12-myristate-13-acetate and lipopolysaccharide, using standardized blood sample from patients at 24 hours. These standard immune activators are implicated in the inflammatory response to gram-negative infection, translocation of microbial products, pathophysiology of septic shock syndrome in human, and tumor promotion. Pain response was gauged using verbal pain scores (on a 0-to 10-point scale, where 0 = no pain and 10 = worst pain) at rest and with activity at 24 hours after surgery and analgesic

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Risk factors associated with surgical site infection in 30 491 primary total hip replacements

Cited by 208 publications

References 29 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

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

Association of Obesity With Inflammation and Pain After Total Hip Arthroplasty

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