Quick But Not Dirty: Short Operative Time and Surgical Site Infection Rates In Knee and Hip Arthroplasty Procedures
Background: Prolonged operative time is a well-established risk factor for surgical site infection (SSI); however, the risk of SSI in procedures with shorter than average operative times has not been well studied. The aim of this study was to examine the relationship between short operative times and SSI rates following hip and knee arthroplasties.
Methods: We analyzed prospectively collected SSI surveillance data from 36 community acute care hospitals and 1 ambulatory surgery center participating in the Duke Infection Control Outreach Network. Patients who developed SSI by National Healthcare Safety Network criteria within 365 days of knee or hip arthroplasties performed from 1/1/2008-12/31/2012 were included in the analysis. Arthroplasties with a duration of <30 minutes or >300 minutes were excluded (522, 0.65%). We ranked procedures by operative time and created five equally distributed operative time groups. We then calculated the SSI rate (SSI/100 procedures) for each group. We followed the same approach to evaluate the relationship between surgeon-specific median operative times and rate of SSI.
Results: 79,572 hip and knee arthroplasties performed by 201 surgeons were included in the analysis. The median operative time for hips and knees was 80 minutes (IQR 62,106) and 83 minutes (IQR 64,106), respectively. The SSI rate was the lowest for arthroplasties in the shortest operative time group (0.78 SSI/100 procedures) compared to the middle group (RR 0.81, 95% CI 0.64-1.03, p-value 0.08); in contrast, SSI rate was highest for arthroplasties in the longest operative time group (1.98 SSI/100 procedures) compared to the middle group (RR 2.04, 95% CI 1.68-2.48, p-value <0.001)(Figure 1). SSI rates were similar across surgeons grouped by median operative time (Figure 2).
Conclusion: SSI risk increased with increasing operative time, but was not increased among surgeons whose median operative time was shorter or longer than their peers. The observed increased SSI risk in prolonged cases is more likely due to case-specific factors than surgeon-specific factors.
K. V. Dicks,
A. W. Baker, None
L. F. Chen, None
D. Anderson, None
D. J. Sexton, UpToDate: Editor, Royalties
National Football League: Consultant, Consulting fee and Educational grant
Cubist: Grant Investigator, Grant recipient
Johnson and Johnson: Consultant, Consulting fee
R. W. Moehring, None
S. S. Lewis, None