Patient and surgical factors affecting procedure duration and revision risk due to deep infection in primary total knee arthroplasty

Kari Indrekvam,Anne Marie Fenstad,Birgitte Espehaug,Håvard Dale,Ove Furnes,Leif I Havelin,Mona Badawy

doi:10.1186/s12891-017-1915-4

Kari Indrekvam, Anne Marie Fenstad + Show 5 more

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https://doi.org/10.1186/s12891-017-1915-4

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Abstract

BackgroundThe aim of this study was to assess which patient and procedure factors affected both the risk of infection as well as procedure duration. Additionally, to assess if procedure duration affected the revision risk due to deep infection in total knee arthroplasty (TKA) patients and in a subgroup of low-risk patients.Methods28,262 primary TKA with 311 revisions due to deep infection were included from the Norwegian Arthroplasty Register (NAR) and analysed from primary surgery from 2005 until 31st December 2015 with a 1 and 4 year follow up. The risk of revision due to deep infection was calculated in a multivariable Cox regression model including patient and procedure related risk factors, assessing Hazard Ratio (HR) with 95% confidence interval (CI).ResultsMultivariate analysis showed statistically significant associations with revision due to deep infection and increased procedure duration for male patients, ASA3+ (American Society of Anesthesiologists) and perioperative complications. Procedure duration ≥110 min (75 percentile) had a higher risk of deep infection compared to duration <75 min (25 percentile), in the unadjusted analysis (HR = 1.8, 95% CI 1.3-2.5, p = 0.001) and in the adjusted analysis (HR = 1.5, 95% CI 1.0-2.1, p = 0.03). For low-risk patients, procedure duration did not increase the risk of infection.ConclusionMale patients, ASA 3+ patients and perioperative complications were risk factors both for longer procedure duration and for deep infection revisions. Patients with a high degree of comorbidity, defined as ASA3+, are at risk of infection with longer procedure durations. The occurrence of perioperative complications potentially leading to a more complex and lengthy procedure was associated with a higher risk of infection. Long procedure duration in itself seems to have minor impact on infection since we found no association in the low-risk patient.

Highlights

The aim of this study was to assess which patient and procedure factors affected both the risk of infection as well as procedure duration
It is critical to identify the correlation of risk factors that predispose total knee arthroplasty (TKA) patients to deep infection, to reduce or even avoid this complication
Males, American Society of Anesthesiologists (ASA) 3+ patients, diagnosis other than OA and the occurrence of perioperative complications were factors associated with long procedure duration and increased risk of deep infection in this study (Table 2)

Summary

Introduction

The aim of this study was to assess which patient and procedure factors affected both the risk of infection as well as procedure duration. To assess if procedure duration affected the revision risk due to deep infection in total knee arthroplasty (TKA) patients and in a subgroup of low-risk patients. Both surgeon and patient related factors can contribute to long procedure duration. Patient related factors increasing procedure duration are male sex, comorbidities, obesity and previous fractures around the knee [7, 8]. These factors are well known risk factors of infection [1, 9,10,11,12,13,14,15]

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