Risk Factors for Surgical Site Infection Following Lower Limb Arthroplasty: A Retrospective Cohort Analysis of 3932 Lower Limb Arthroplasty Procedures in a High Volume Arthroplasty Unit

Almustafa, Mohammed; Ewen, Alistair; Deakin, A.H.; Picard, F.; Clarke, Jon; Mahmood, Fahd

doi:10.1016/j.arth.2018.01.037

Cited by 32 publications

(29 citation statements)

References 43 publications

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“…This meticulous post-operative follow-up con rms that the number of recorded incidents of SSSI are accurate, and the follow-up time of ve years, highlights any potential cases of PJI. Similar studies present a larger cohort but are based on registers only (41,42) or have a shorter follow-up time (7,8,41).…”

Section: Resultsmentioning

confidence: 90%

“Patient-Related Risk Factors For Superficial Surgical Site Infection And The Correlation To Periprosthetic Joint Infection – A 5year Follow-up Of 1291 Elective Primary Total Joint Arthroplasties”

Eriksson

Lazarinis

2020

Preprint

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Background: The incidence of superficial surgical site infection (SSSI) may increase the risk of subsequent periprosthetic joint infection (PJI). Optimisation or even avoiding patient-related risk factors for SSSI preoperatively, may decrease the risk of subsequent PJI. Purpose: To identify patient-related risk factors associated with SSSI and investigate their correlation with the progression of PJI. Methods: 1,291 primary elective hip and knee prosthesis were included. Patients were personally contacted by a nurse ≥ 3 month after surgery to answer questions about the postoperative period, including any occurrences of SSSI. The diagnosed PJI was determined by an orthopaedic surgeon together with a specialist in infectious diseases, and all patients with PJI underwent revision surgery. The patient-related risk factors considered relevant were joint, age, sex, American Society of Anesthesiologists classification (ASA), body mass index (BMI), smoking, diabetes and rheumatological disease. Results: 7,0 % of included patients developed an SSSI, and 1,9 % a PJI. Factors with a significantly increased adjusted risk ratio for SSSI were; knee surgery 1,9 (95% CI: 1,2 – 3,1), age ≥ 65 years 1,7 (95% CI: 1,1 – 2,8), BMI ≥35 2,3 (95% CI: 1,2 – 4,2) and for PJI; knee surgery 2,6 (95% CI: 1,1 – 6,4), ASA-class ≥ 3 3,2 (95% CI: 1,3 – 7,9), BMI ≥35 3,0 (95% CI: (1,2 – 4,2) and male gender 3,0 (95% CI: (1,2 – 7,5). Male patients showed a significant risk of developing PJI following SSSI, with a risk ratio of 3,3 (95% CI: 1,1 – 10,5).Conclusions: Male patients planned for total knee prostheses (TKA) aged 65 or over, with high ASA-class and high BMI should be selected with care due to the increased risk of postoperative infection.

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Section: Resultsmentioning

confidence: 90%

“Patient-Related Risk Factors For Superficial Surgical Site Infection And The Correlation To Periprosthetic Joint Infection – A 5year Follow-up Of 1291 Elective Primary Total Joint Arthroplasties”

Eriksson

Lazarinis

2020

Preprint

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“…Most studies looking at these complications focused on staples compared to suture or one of the newer tape and glue systems. Many analyzed wound complications for knotless barbed suture compared to standard absorbable suture for skin closure with mixed results in prospective randomized control trials despite a universal reduction in closure time [7][8][9][10][11][12][13][14] . In a prospective randomized control trial by Khan, et al, the Dermabond skin closure group showed less drainage within the first 24 hours but more overall in follow-up when compared to monocryl suture 15 .…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, a study by Almustafa, et al retrospectively reviewed a cohort of 3,932 TKAs and risk of surgical site infection with various closure systems. They found that there were not enough cases of infection in the subgroups to run logistic regressions despite their large cohort 13 .…”

Section: Discussionmentioning

confidence: 99%

Wound Complications after 2-Octyl Skin Closure Systems for Total Joint Arthroplasty

Michalowitz

Comrie

Nicholas

et al. 2020

J. Bone Joint Infect.

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Abstract. Introduction: Total joint arthroplasty is projected to expand rapidly by 2030. With large numbers of patients undergoing TJA, the choice of incisional closure has come into question. We compared the 2-Ocyl cyanoacrylate closure system of Dermabond ® Prineo ® with Exofin Fusion ® to compare rates of adverse wound outcomes after total joint arthroplasty. Secondary outcome measures were age, sex, and medical comorbidities between groups.Methods: We retrospectively reviewed adverse wound outcomes with skin closure in TJA in 281 patients (160 Dermabond Prineo and 121 Exofin Fusion). Clinical charts were analyzed out to the 6-week post-op visit.Results: The rate of overall adverse superficial wound outcomes was similar between the two groups with Dermabond Prineo (N=20) and Exofin Fusion (N=19). The rate of cellulitis was significantly higher for Dermabond Prineo when compared to Exofin Fusion (P=0.033). No other significant differences were found for rate of superficial or deep wound complications or for secondary outcomes.Conclusions: The two 2-octyl wound closure systems had similar adverse superficial wound complications. Except for Dermabond Prineo having a higher rate of post-operative cellulitis, there were no statistically significant differences for other superficial or deep adverse wound outcomes or secondary outcomes. A future randomized control trial or prospective cohort study is needed for a more robust analysis.

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“…Tissue adhesive had some potential advantages such as ease of use, painless application, rapid closure, cosmesis, and avoidance of needlestick injuries and removal of the suture or staples [8]. It was also applied in a high volume arthroplasty unit for skin closure and did not increase the risk of surgical site infection in THA [9]. This technique also provided an immediate water tight seal in a sterile operative environment and a barrier to microorganisms; it had good tensile strength, esthetic value, and patient satisfaction [10].…”

Section: Introductionmentioning

confidence: 99%

Octyl-2-cyanoacrylate tissue adhesive without subcuticular suture for wound closure after total hip arthroplasty: a prospective observational study on thirty-two cases with controls for 3 months follow-up

Wang

et al. 2020

J Orthop Surg Res

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Background Whether using tissue adhesive alone after subcutaneous suture can close the skin incision with safety as well as cosmetic appearance after total hip arthroplasty was not clear. Methods A prospective study was conducted. The same surgical methods were consistent throughout the entire study. After implanting prosthesis, the joint capsule was reconstructed. Fascial and subcutaneous layer were respectively closed by continuous running barbed suture. Patients were randomized allocated to group A with octyl-2-cyanoacrylate tissue adhesive alone, to group B with tissue adhesive after continuous subcuticular suture, or to group C with skin staples. Time of closure, drainage, pain, wound complications, and cosmesis were compared. All data were analyzed statistically. Results There was no significant difference in drainage, Visual Analog Scale score or early wound complications between the three groups. However, there was significant difference in time of closure (P = 0.013). In pairwise comparison, time of closure in groups A and B was significantly longer than those in group C (P = 0.001 and P = 0.023, respectively); time of closure in group A was significantly shorter than those in group B (P = 0.003). Patient and Observer Scar Assessment Scale total scores were not significantly different at 6 weeks and 3 months postoperatively (P = 0.078 and P = 0.284, respectively). Conclusion Tissue adhesive without subcuticular suture was similar with a combination of subcuticular suture and tissue adhesive as well skin staples in terms of safety and cosmetic appearance after total hip arthroplasty.

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Risk Factors for Surgical Site Infection Following Lower Limb Arthroplasty: A Retrospective Cohort Analysis of 3932 Lower Limb Arthroplasty Procedures in a High Volume Arthroplasty Unit

Cited by 32 publications

References 43 publications

“Patient-Related Risk Factors For Superficial Surgical Site Infection And The Correlation To Periprosthetic Joint Infection – A 5year Follow-up Of 1291 Elective Primary Total Joint Arthroplasties”

“Patient-Related Risk Factors For Superficial Surgical Site Infection And The Correlation To Periprosthetic Joint Infection – A 5year Follow-up Of 1291 Elective Primary Total Joint Arthroplasties”

Wound Complications after 2-Octyl Skin Closure Systems for Total Joint Arthroplasty

Octyl-2-cyanoacrylate tissue adhesive without subcuticular suture for wound closure after total hip arthroplasty: a prospective observational study on thirty-two cases with controls for 3 months follow-up

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