Surgical duration is associated with an increased risk of periprosthetic infection following total knee arthroplasty: A population-based retrospective cohort study

Abstract

BackgroundTotal knee arthroplasty (TKA) is one the most common elective procedures in the world. Post-operative infection is one of its most devastating complications, often necessitating multiple additional surgeries. We aimed to describe the relationship between surgical duration and risk of deep infection following primary elective TKA.MethodsIn this cohort study we analyses primary TKAs done between 2009 and 2016 in Ontario, Canada. We utilized restricted cubic splines to identify a threshold of surgical duration that was associated with an increased risk for infection requiring surgery. Patients with a ‘short’ duration of surgery were matched to those with a ‘long’ duration on patient age (±3 years), patient sex, severe obesity (BMI > 40), the primary surgeon, the hospital and the type of anesthetic.FindingsIn 92,343 primary TKAs, the median surgical duration was 106 min. We identified a cut-point of 100 min that was associated with an increased risk for infection. Subsequently, 17,815 TKA recipients with a ‘long’ procedure length were matched to those with a ‘short’ procedure length. ‘Long’ procedures had a higher rate of deep infection (1.1% versus 0.6%, p < 0.0001). This was equal to a relative risk of 1.81 (p < 0.0001).InterpretationIn a cohort of TKA recipients, we found that procedure lengths longer than 100 min were associated with a significantly increased risk of deep infection requiring surgery. This time threshold serves a useful time-point to identify patients that require closer surveillance.

Does the Duration of Primary and First Revision Surgery Influence the Probability of First and Subsequent Implant Failures after Extremity Sarcoma Resection and Megaprosthetic Reconstruction?

“…Orthopaedic oncologists are therefore required to evaluate possible risk factors for failure and, ideally, identify areas of optimization potential. The length of surgery as a potential risk factor has been studied previously [ 20 ]; however, previous results have been inconclusive [ 13 , 14 , 15 ]. As sarcoma resection and megaprosthetic reconstructions have a longer surgical duration and are associated with a higher risk of failure compared to non-oncological arthroplasty procedures [ 18 , 21 ], modifying a procedure related risk factor, such as the duration of the surgery, would offer surgeons a chance to reduce the burden of megaprosthetic revision.…”

<p>Infection Risk-Adjusted Antibiotic Prophylaxis Strategies in Arthroplasty: Short Review of Evidence and Experiences of a Tertiary Center in Spain</p>

“…Based on the retrospective analysis of more than 92.000 patients undergoing TKA in the Ontario region of Canada between 2009 and 2016 Ravi et al recently found a statistically significant relation between procedure lengths and the number of deep infections. 25 They observed that patients with a "long" surgical duration (≥100 min) suffered from a higher rate of PJI within a year of their surgery than patients with a "short" duration (1.1% versus 0.6%). Similar results were also obtained by Garbarino et al 24 who observed higher PJI rates in cases >121 minutes duration of surgery (1.4%) compared to those <85 minutes (0.3%).…”

The current state of robotics in total knee arthroplasty

“… 69 The failure and abandonment of ROBODOC mid-procedure meant surgical times in theatre were protracted, reducing theatre time utilization and increasing concerns of infection. 69 , 79 , 80 These potential extra costs and lack of superior survivorship data combined with the initial upfront and running costs of approximately $545,000 and $1,360 respectively, failed to prove robotic TKA was cost-effective. 81 …”