Recent Respiratory Tract Infection and Additional Surgeries Increase Risk for Surgical Site Infection in Total Joint Arthroplasty: A Retrospective Analysis of 2255 Patients

Abstract

Background Surgical site infections (SSI) are one of the most common healthcare-associated infections contributing to high economic burden. Around 658,000 total joint arthroplasties (TJA) are performed annually in the Unites States, estimated 0.9–2.5% develop surgical site infection. Despite following prevention guidelines, SSI continues to occur. The aim of our study was to identify perioperative risk factors for SSI in patients undergoing TJA.Methods A retrospective cohort study was performed of patients at the Detroit Medical Center from 2011 to 2015. All adult patients undergoing primary or revision total knee or hip joint arthroplasty were included. Patients were divided into SSI (prosthetic joint infections) and non-SSI group. Baseline characteristics and perioperative variables influencing SSI were assessed. Statistical analysis was performed using SAS software. Continuous variables were compared using Wilcoxon–Rank-sum test and categorical variables using Fischer’s exact test.ResultsAmong 2255 included patients, 1203 had knee arthroplasties (53%), 1052 had hip arthroplasties (47%) and SSI occurred in 46 patients (2%). Overall, mean age was 58.81 ± 11 years; 64% were females, 57% were African American, and 41% were smokers. Diabetes did not increase risk for SSI (37% with SSI vs. 26% without SSI; P = 0.09). Administration of general anesthesia, American Society of Anesthesiologists score of ≥2, the presence of hypothermia and hyperglycemia did not statistically increase the risk for SSI. Patients with recent respiratory tract infection in previous 30 days prior to surgery were more likely to develop infection compared with patients without recent infection (20% vs. 6.6%, OR 3.42; 95% confidence interval 1.62–7.22, P = 0.0034). Any additional surgery within 90 days of arthroplasty increased risk for infection (22% vs. 11%, P = 0.03). Among the 46 SSIs, knee surgeries experienced more infections than hip surgeries (67% vs. 33%, P = 0.07).Conclusion In this study, recent respiratory tract infection in 30 days prior to surgery and additional surgeries within 90 days after arthroplasty increased risk for SSI. Careful preoperative assessment and sufficient time to postoperative recovery is essential to reduce SSI. Further multicenter studies are needed to validate our findings.Disclosures All authors: No reported disclosures.