Association Between Operative Time and SSI in TKA and THA Patients

Lerone Fong, RN, DNP, CRNA

DNP Nurse Anesthesia

Association Between Operative Time and SSI in TKA and THA Patients

Project Category:  Evidence Synthesis 

Project Team: Lerone Fong, DNP, CRNA Dilpreet Wander, DNP, CRNA Peter Kallio, CRNA< DNP (Advisor)

Abstract

Background: Arthroplasty, or joint replacement surgery, represents approximately 2 million hip and knee surgical procedures, and is increasing year every year in the United States.  A devastating and costly complication associated with primary total joint arthroplasty are surgical site infections which have an annual impact of $10 billion in additional costs. Recognizing and understanding correlations between operative time and surgical site infection in total joint arthroplasty will help to further research into factors to address and help prevent the phenomenon.  The purpose of this study was to perform a systematic review on the association between operative time and surgical site infection (SSI) after total hip arthroplasty and total knee arthroplasty.  

Methods: An integrative review was conducted utilizing a systematic search of PubMed, Ovid Medline, and CINAHL databases to identify research regarding a possible correlation between operative time and SSI occurrence after total hip and total knee arthroplasty procedures. Studies were screened for inclusion by two independent reviewers. Study findings were further grouped into total knee arthroplasty and total hip arthroplasty for comparison of factors that influence SSI. A third grouping was utilized to compare studies that did not differentiate between total knee and total hip arthroplasties. 

Results: A total of 11 retrospective cohort studies were included in the integrative review.  The rates of surgical site infections in primary total joint arthroplasty procedures are significantly greater when operative time exceeds 120-minute (p<0.001).  In addition, a collective group of total knee and total hip arthroplasties indicated increased risk at the start of 90-minute operative time for periprosthetic joint infections (adjusted OR 1.01 [95% Cl 1.01-1.012].  

Conclusion: A correlation between increased rates of surgical site infections and increased operative times has been replicated in multiple studies.  Providers should further examine processes to limit operative time.

Full Manuscript Slide Presentation Video