Does Operative Time Affect Infection Rate in Primary Total Knee Arthroplasty?
Background Prolonged operative time may increase the risk of infection after total knee arthroplasty (TKA). Both surgeon-related and patient-related factors can contribute to increased operative times. Questions/purposes The purpose of this study was to determine (1) whether increased operative time...
Gespeichert in:
| Veröffentlicht in: | Clinical orthopaedics and related research 2015-01, Vol.473 (1), p.64-69 |
|---|---|
| Hauptverfasser: | , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 69 |
|---|---|
| container_issue | 1 |
| container_start_page | 64 |
| container_title | Clinical orthopaedics and related research |
| container_volume | 473 |
| creator | Naranje, Sameer Lendway, Lisa Mehle, Susan Gioe, Terence J. |
| description | Background
Prolonged operative time may increase the risk of infection after total knee arthroplasty (TKA). Both surgeon-related and patient-related factors can contribute to increased operative times.
Questions/purposes
The purpose of this study was to determine (1) whether increased operative time is an independent risk factor for revision resulting from infection after TKA; (2) whether increasing body mass index (BMI) increased operative time; and (3) whether increasing experience substantially decreased operative time.
Methods
We retrospectively evaluated primary TKAs from our joint registry between March 2000 and August 2012. Cox proportional hazard models were used to assess the relationship between operative time and revision resulting from infection after accounting for age, sex, BMI, and Agency for Healthcare Research and Quality comorbidity score. Of 9973 instances of primary TKA, 73 underwent revision surgery for infection (0.73%).
Results
After accounting for the confounders of age and sex, operative time was not found to have a significant effect; a 15-minute increase in operative time increased the hazard of revision resulting from infection by only 15.6% (p = 0.053; 95% confidence interval, 0.0%–34.0%). In addition, a five-unit increase in BMI was found to increase mean operative time by 1.9 minutes, on average, regardless of sex (p |
| doi_str_mv | 10.1007/s11999-014-3628-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4390911</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3535562391</sourcerecordid><originalsourceid>FETCH-LOGICAL-c569t-b56251acef6432a39ed2996592b1820100f9bce91e05f67d346fcdc248b807e23</originalsourceid><addsrcrecordid>eNp1kV9LHDEUxUOp6HbrB-hLCfSlL1Nzk0xm8lIR-0dRsZQt9C1ksnd0ZDbZJlnBb2-WUbGCTzfh_nLuuTmEfAD2BRhrDhKA1rpiICuheFvJN2QGdTkACP6WzBhjutIc_u6RdyndlKuQNd8le1w2kgloZ-TiW8BEL9cYbR5ukS6GFdKjvkeX6anfliF4-ttmpIOnv-KwsvGOLkK2Iz3zWNiYr2NYjzblu8P3ZKe3Y8L9hzonf358XxyfVOeXP0-Pj84rVyudq65WvAbrsFdScCs0LrnWqta8g5azsluvO4cakNW9apZCqt4tHZdt17IGuZiTr5PuetOtcOnQ52hHs57smWAH83_HD9fmKtwaKTTT5Xfm5PODQAz_NpiyWQ3J4Thaj2GTDCjJZMtrJgr66QV6EzbRl_UKJXSrGhBbCibKxZBSxP7JDDCzDctMYZkSltmGVazMycfnWzy9eEynAHwCUmn5K4zPRr-qeg_GOJ7B</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1639867133</pqid></control><display><type>article</type><title>Does Operative Time Affect Infection Rate in Primary Total Knee Arthroplasty?</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>SpringerLink Journals - AutoHoldings</source><creator>Naranje, Sameer ; Lendway, Lisa ; Mehle, Susan ; Gioe, Terence J.</creator><creatorcontrib>Naranje, Sameer ; Lendway, Lisa ; Mehle, Susan ; Gioe, Terence J.</creatorcontrib><description>Background
Prolonged operative time may increase the risk of infection after total knee arthroplasty (TKA). Both surgeon-related and patient-related factors can contribute to increased operative times.
Questions/purposes
The purpose of this study was to determine (1) whether increased operative time is an independent risk factor for revision resulting from infection after TKA; (2) whether increasing body mass index (BMI) increased operative time; and (3) whether increasing experience substantially decreased operative time.
Methods
We retrospectively evaluated primary TKAs from our joint registry between March 2000 and August 2012. Cox proportional hazard models were used to assess the relationship between operative time and revision resulting from infection after accounting for age, sex, BMI, and Agency for Healthcare Research and Quality comorbidity score. Of 9973 instances of primary TKA, 73 underwent revision surgery for infection (0.73%).
Results
After accounting for the confounders of age and sex, operative time was not found to have a significant effect; a 15-minute increase in operative time increased the hazard of revision resulting from infection by only 15.6% (p = 0.053; 95% confidence interval, 0.0%–34.0%). In addition, a five-unit increase in BMI was found to increase mean operative time by 1.9 minutes, on average, regardless of sex (p < 0.0001). Operative time decreases with increasing experience but appears to plateau at approximately 300 surgeries.
Conclusions
Operative time is only one of many factors that may increase infection risk and may be influenced by numerous confounders. Increasing BMI increased operative time but the effect was modest. The effect of increasing experience on operative duration of this common procedure was surprisingly limited among our surgeons.
Level of Evidence
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.</description><identifier>ISSN: 0009-921X</identifier><identifier>EISSN: 1528-1132</identifier><identifier>DOI: 10.1007/s11999-014-3628-4</identifier><identifier>PMID: 24740318</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Arthroplasty, Replacement, Knee - adverse effects ; Arthroplasty, Replacement, Knee - instrumentation ; Body Mass Index ; Clinical Competence ; Conservative Orthopedics ; Humans ; Knee ; Knee Joint - surgery ; Knee Prosthesis - adverse effects ; Learning Curve ; Medicine ; Medicine & Public Health ; Minnesota ; Obesity - complications ; Obesity - diagnosis ; Operative Time ; Orthopedics ; Proportional Hazards Models ; Prosthesis Design ; Prosthesis-Related Infections - etiology ; Registries ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Sports Medicine ; Surgery ; Surgical Orthopedics ; Symposium: 2014 Knee Society Proceedings ; Time Factors ; Treatment Outcome</subject><ispartof>Clinical orthopaedics and related research, 2015-01, Vol.473 (1), p.64-69</ispartof><rights>The Association of Bone and Joint Surgeons® 2014</rights><rights>The Association of Bone and Joint Surgeons 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c569t-b56251acef6432a39ed2996592b1820100f9bce91e05f67d346fcdc248b807e23</citedby><cites>FETCH-LOGICAL-c569t-b56251acef6432a39ed2996592b1820100f9bce91e05f67d346fcdc248b807e23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390911/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390911/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,41488,42557,51319,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24740318$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Naranje, Sameer</creatorcontrib><creatorcontrib>Lendway, Lisa</creatorcontrib><creatorcontrib>Mehle, Susan</creatorcontrib><creatorcontrib>Gioe, Terence J.</creatorcontrib><title>Does Operative Time Affect Infection Rate in Primary Total Knee Arthroplasty?</title><title>Clinical orthopaedics and related research</title><addtitle>Clin Orthop Relat Res</addtitle><addtitle>Clin Orthop Relat Res</addtitle><description>Background
Prolonged operative time may increase the risk of infection after total knee arthroplasty (TKA). Both surgeon-related and patient-related factors can contribute to increased operative times.
Questions/purposes
The purpose of this study was to determine (1) whether increased operative time is an independent risk factor for revision resulting from infection after TKA; (2) whether increasing body mass index (BMI) increased operative time; and (3) whether increasing experience substantially decreased operative time.
Methods
We retrospectively evaluated primary TKAs from our joint registry between March 2000 and August 2012. Cox proportional hazard models were used to assess the relationship between operative time and revision resulting from infection after accounting for age, sex, BMI, and Agency for Healthcare Research and Quality comorbidity score. Of 9973 instances of primary TKA, 73 underwent revision surgery for infection (0.73%).
Results
After accounting for the confounders of age and sex, operative time was not found to have a significant effect; a 15-minute increase in operative time increased the hazard of revision resulting from infection by only 15.6% (p = 0.053; 95% confidence interval, 0.0%–34.0%). In addition, a five-unit increase in BMI was found to increase mean operative time by 1.9 minutes, on average, regardless of sex (p < 0.0001). Operative time decreases with increasing experience but appears to plateau at approximately 300 surgeries.
Conclusions
Operative time is only one of many factors that may increase infection risk and may be influenced by numerous confounders. Increasing BMI increased operative time but the effect was modest. The effect of increasing experience on operative duration of this common procedure was surprisingly limited among our surgeons.
Level of Evidence
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.</description><subject>Arthroplasty, Replacement, Knee - adverse effects</subject><subject>Arthroplasty, Replacement, Knee - instrumentation</subject><subject>Body Mass Index</subject><subject>Clinical Competence</subject><subject>Conservative Orthopedics</subject><subject>Humans</subject><subject>Knee</subject><subject>Knee Joint - surgery</subject><subject>Knee Prosthesis - adverse effects</subject><subject>Learning Curve</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Minnesota</subject><subject>Obesity - complications</subject><subject>Obesity - diagnosis</subject><subject>Operative Time</subject><subject>Orthopedics</subject><subject>Proportional Hazards Models</subject><subject>Prosthesis Design</subject><subject>Prosthesis-Related Infections - etiology</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Symposium: 2014 Knee Society Proceedings</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0009-921X</issn><issn>1528-1132</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kV9LHDEUxUOp6HbrB-hLCfSlL1Nzk0xm8lIR-0dRsZQt9C1ksnd0ZDbZJlnBb2-WUbGCTzfh_nLuuTmEfAD2BRhrDhKA1rpiICuheFvJN2QGdTkACP6WzBhjutIc_u6RdyndlKuQNd8le1w2kgloZ-TiW8BEL9cYbR5ukS6GFdKjvkeX6anfliF4-ttmpIOnv-KwsvGOLkK2Iz3zWNiYr2NYjzblu8P3ZKe3Y8L9hzonf358XxyfVOeXP0-Pj84rVyudq65WvAbrsFdScCs0LrnWqta8g5azsluvO4cakNW9apZCqt4tHZdt17IGuZiTr5PuetOtcOnQ52hHs57smWAH83_HD9fmKtwaKTTT5Xfm5PODQAz_NpiyWQ3J4Thaj2GTDCjJZMtrJgr66QV6EzbRl_UKJXSrGhBbCibKxZBSxP7JDDCzDctMYZkSltmGVazMycfnWzy9eEynAHwCUmn5K4zPRr-qeg_GOJ7B</recordid><startdate>20150101</startdate><enddate>20150101</enddate><creator>Naranje, Sameer</creator><creator>Lendway, Lisa</creator><creator>Mehle, Susan</creator><creator>Gioe, Terence J.</creator><general>Springer US</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20150101</creationdate><title>Does Operative Time Affect Infection Rate in Primary Total Knee Arthroplasty?</title><author>Naranje, Sameer ; Lendway, Lisa ; Mehle, Susan ; Gioe, Terence J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c569t-b56251acef6432a39ed2996592b1820100f9bce91e05f67d346fcdc248b807e23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Arthroplasty, Replacement, Knee - adverse effects</topic><topic>Arthroplasty, Replacement, Knee - instrumentation</topic><topic>Body Mass Index</topic><topic>Clinical Competence</topic><topic>Conservative Orthopedics</topic><topic>Humans</topic><topic>Knee</topic><topic>Knee Joint - surgery</topic><topic>Knee Prosthesis - adverse effects</topic><topic>Learning Curve</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Minnesota</topic><topic>Obesity - complications</topic><topic>Obesity - diagnosis</topic><topic>Operative Time</topic><topic>Orthopedics</topic><topic>Proportional Hazards Models</topic><topic>Prosthesis Design</topic><topic>Prosthesis-Related Infections - etiology</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Symposium: 2014 Knee Society Proceedings</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Naranje, Sameer</creatorcontrib><creatorcontrib>Lendway, Lisa</creatorcontrib><creatorcontrib>Mehle, Susan</creatorcontrib><creatorcontrib>Gioe, Terence J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical orthopaedics and related research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Naranje, Sameer</au><au>Lendway, Lisa</au><au>Mehle, Susan</au><au>Gioe, Terence J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does Operative Time Affect Infection Rate in Primary Total Knee Arthroplasty?</atitle><jtitle>Clinical orthopaedics and related research</jtitle><stitle>Clin Orthop Relat Res</stitle><addtitle>Clin Orthop Relat Res</addtitle><date>2015-01-01</date><risdate>2015</risdate><volume>473</volume><issue>1</issue><spage>64</spage><epage>69</epage><pages>64-69</pages><issn>0009-921X</issn><eissn>1528-1132</eissn><abstract>Background
Prolonged operative time may increase the risk of infection after total knee arthroplasty (TKA). Both surgeon-related and patient-related factors can contribute to increased operative times.
Questions/purposes
The purpose of this study was to determine (1) whether increased operative time is an independent risk factor for revision resulting from infection after TKA; (2) whether increasing body mass index (BMI) increased operative time; and (3) whether increasing experience substantially decreased operative time.
Methods
We retrospectively evaluated primary TKAs from our joint registry between March 2000 and August 2012. Cox proportional hazard models were used to assess the relationship between operative time and revision resulting from infection after accounting for age, sex, BMI, and Agency for Healthcare Research and Quality comorbidity score. Of 9973 instances of primary TKA, 73 underwent revision surgery for infection (0.73%).
Results
After accounting for the confounders of age and sex, operative time was not found to have a significant effect; a 15-minute increase in operative time increased the hazard of revision resulting from infection by only 15.6% (p = 0.053; 95% confidence interval, 0.0%–34.0%). In addition, a five-unit increase in BMI was found to increase mean operative time by 1.9 minutes, on average, regardless of sex (p < 0.0001). Operative time decreases with increasing experience but appears to plateau at approximately 300 surgeries.
Conclusions
Operative time is only one of many factors that may increase infection risk and may be influenced by numerous confounders. Increasing BMI increased operative time but the effect was modest. The effect of increasing experience on operative duration of this common procedure was surprisingly limited among our surgeons.
Level of Evidence
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>24740318</pmid><doi>10.1007/s11999-014-3628-4</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0009-921X |
| ispartof | Clinical orthopaedics and related research, 2015-01, Vol.473 (1), p.64-69 |
| issn | 0009-921X 1528-1132 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4390911 |
| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central; SpringerLink Journals - AutoHoldings |
| subjects | Arthroplasty, Replacement, Knee - adverse effects Arthroplasty, Replacement, Knee - instrumentation Body Mass Index Clinical Competence Conservative Orthopedics Humans Knee Knee Joint - surgery Knee Prosthesis - adverse effects Learning Curve Medicine Medicine & Public Health Minnesota Obesity - complications Obesity - diagnosis Operative Time Orthopedics Proportional Hazards Models Prosthesis Design Prosthesis-Related Infections - etiology Registries Retrospective Studies Risk Assessment Risk Factors Sports Medicine Surgery Surgical Orthopedics Symposium: 2014 Knee Society Proceedings Time Factors Treatment Outcome |
| title | Does Operative Time Affect Infection Rate in Primary Total Knee Arthroplasty? |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-08T01%3A10%3A40IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Does%20Operative%20Time%20Affect%20Infection%20Rate%20in%20Primary%20Total%20Knee%20Arthroplasty?&rft.jtitle=Clinical%20orthopaedics%20and%20related%20research&rft.au=Naranje,%20Sameer&rft.date=2015-01-01&rft.volume=473&rft.issue=1&rft.spage=64&rft.epage=69&rft.pages=64-69&rft.issn=0009-921X&rft.eissn=1528-1132&rft_id=info:doi/10.1007/s11999-014-3628-4&rft_dat=%3Cproquest_pubme%3E3535562391%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1639867133&rft_id=info:pmid/24740318&rfr_iscdi=true |