Surgical Case Order Has an Effect on the Risk of Subsequent Periprosthetic Joint Infection

Abstract Background Periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) is a serious complication with multiple etiologies. Prior spine literature has shown that later cases in the day were more likely to develop surgical site infection. However, the effect of case order on PJI after TJA is unknown. This study aims to determine the influence of case order, prior infected case, and terminal cleaning on the risk for subsequent PJI. Methods A retrospective, single-institution study was conducted on 31,499 TJAs performed from 2000-2014. Case order was determined by case start times per date within the same operating room. PJI was defined by the Musculoskeletal Infection Society criteria. Logistic regression was used to determine risk factors for subsequent PJI. Results Non-infected cases followed an infected case in 92/31,499 cases (0.29%), and were more likely to develop PJI (adjusted odds ratio [OR] 2.43, p=0.029). However, terminal cleaning after infected cases did not affect risk for PJI in cases the following morning (OR 1.42, p=0.066). Case order had an OR of 0.98 (p=0.655), implying that later cases did not have a higher likelihood of infection. Conclusion While surgical case order is not an independent risk factor for subsequent PJI, TJA cases following an infected case in the same room on the same day have a higher infection risk. Despite improved sterile technique and clean air operating rooms, the risk of contaminating a TJA with pathogens from a prior infected case appears to be high. Terminal cleaning appears to be effective in reducing bioburden in the operating room. Level of Evidence III