The Rothman Institute at Thomas Jefferson University, Philadelphia, PA; Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, People's Republic of China.
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
J Arthroplasty. 2019 May;34(5):947-953. doi: 10.1016/j.arth.2019.01.027. Epub 2019 Jan 18.
Whether prolonged operative time is an independent risk factor for subsequent surgical site infection (SSI) and periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) remains a clinically significant and underexplored issue. The aim of this study is to investigate the association between operative time and the risk of subsequent SSI and PJI in patients undergoing primary TJA.
We retrospectively reviewed 17,342 primary unilateral total knee arthroplasty and total hip arthroplasty performed at a single institution between 2005 and 2016, with a minimum follow-up of 1 year. A multivariate logistic regression model was conducted to identify the association between operative time and the development of SSI within 90 days and PJI within 1 year.
Overall, the incidence of 90-day SSI and 1-year PJI was 1.2% and 0.8%, respectively. Patients with an operative time of >90 minutes had a significantly higher incidence of SSI and PJI (2.1% and 1.4%, respectively) compared to cases lasting between 60 and 90 minutes (1.1% and 0.7%), and those lasting ≤60 minutes (0.9% and 0.7%, P < .01). In the multivariate model, the risk for infection increased by an odds ratio of 1.346 (95% confidential interval 1.114-1.627) for 90-day SSI and 1.253 (95% confidential interval 1.060-1.481) for 1-year PJI for each 20-minute increase in operative time.
In patients undergoing primary TJA, each 20-minute increase in operative time was associated with nearly a 25% increased risk of subsequent PJI. We advocate that surgeons pay close attention to this underappreciated risk factor while maintaining safe operative practices, which minimize unnecessary steps and wasted time in the operating room.
全膝关节置换术（TKA）和全髋关节置换术后手术时间延长是否是手术部位感染（SSI）和假体周围关节感染（PJI）的独立危险因素，这仍是一个具有重要临床意义但尚未得到充分研究的问题。本研究旨在探讨初次 TKA 患者手术时间与 SSI 和 PJI 风险之间的关系。
我们回顾性分析了 2005 年至 2016 年期间在一家机构进行的 17342 例单侧初次 TKA，随访时间至少为 1 年。采用多变量 logistic 回归模型来确定手术时间与术后 90 天内 SSI 和 1 年内 PJI 发生之间的关系。
总体而言，90 天 SSI 和 1 年 PJI 的发生率分别为 1.2%和 0.8%。手术时间>90 分钟的患者 SSI 和 PJI 的发生率明显高于手术时间 60-90 分钟的患者（分别为 2.1%和 1.4%，0.7%和 0.7%），也高于手术时间≤60 分钟的患者（分别为 0.9%和 0.7%，P<.01）。在多变量模型中，手术时间每增加 20 分钟，90 天 SSI 的感染风险增加 1.346 倍（95%置信区间 1.114-1.627），1 年 PJI 的感染风险增加 1.253 倍（95%置信区间 1.060-1.481）。
在初次 TKA 患者中，手术时间每增加 20 分钟，随后发生 PJI 的风险增加近 25%。我们主张外科医生在保持安全手术操作的同时，密切关注这一被低估的危险因素，尽量减少手术室中不必要的步骤和浪费的时间。
