Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital, Shanghai, China.
JAMA Netw Open. 2020 Oct 1;3(10):e2021194. doi: 10.1001/jamanetworkopen.2020.21194.
Whether laminar airflow (LAF) in the operating room is effective for decreasing periprosthetic joint infection (PJI) after total joint arthroplasty remains a clinically important yet controversial issue.
To investigate the association between operating room LAF ventilation systems and the risk of PJI in patients undergoing total joint arthroplasty.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted of 6972 consecutive patients undergoing primary total knee arthroplasty or total hip arthroplasty at 2 surgical facilities within a single institution from January 1, 2013, to September 15, 2017, with a minimum of 1 year of follow-up. All procedures were performed by 5 board-certified arthroplasty surgeons. Statistical analysis was performed from January 1, 2014, to September 15, 2018.
Patients underwent total joint arthroplasty in operating rooms equipped with either LAF or turbulent airflow.
Patient characteristics were extracted from clinical records. Periprosthetic joint infection was defined according to Musculoskeletal Infection Society criteria within 1 year of the index arthroplasty. A multivariable logistic regression model was performed to explore the potential association between LAF and risk of PJI at 1 year, and then a sensitivity analysis using propensity score matching was performed to further validate the findings.
A total of 6972 patients (2797 who underwent total knee arthroplasty and 4175 who underwent total hip arthroplasty; 3690 women [52.9%]; mean [SD] age, 63.9 [10.7] years) were included. The incidence of PJI within 1 year for patients from the facility without LAF was similar to that of patients from the facility with LAF (0.4% [12 of 3027] vs 0.5% [21 of 3945]). In the multivariable logistic regression analysis, after all confounding factors were taken into account, the use of LAF was not associated with a reduction of the risk of PJI (adjusted odds ratio, 0.94; 95% CI, 0.40-2.19; P = .89). After propensity score matching, there was no significant difference in the incidence of PJI within 1 year for patients who underwent total joint arthroplasty at these 2 sites.
This study suggests that the use of LAF in the operating room was not associated with a reduced incidence of PJI after primary total joint arthroplasty. With an appropriate perioperative protocol for infection prevention, LAF does not seem to play a protective role in PJI prevention.
层流（LAF）在手术室中是否能降低全关节置换术后假体周围关节感染（PJI）的风险仍然是一个具有临床重要意义但存在争议的问题。
调查手术室 LAF 通风系统与全关节置换术后 PJI 风险之间的关联。
设计、地点和参与者：这是一项在一家医疗机构的 2 个手术场所进行的 6972 例连续原发性全膝关节置换术或全髋关节置换术患者的回顾性队列研究，随访时间至少为 1 年。所有手术均由 5 名经过董事会认证的关节置换外科医生进行。统计分析于 2014 年 1 月 1 日至 2018 年 9 月 15 日进行。
患者在配备 LAF 或紊流的手术室中接受全关节置换术。
从临床记录中提取患者特征。假体周围关节感染根据 1 年内的肌肉骨骼感染协会标准定义。采用多变量逻辑回归模型探讨 LAF 与 1 年时 PJI 风险之间的潜在关联，然后采用倾向评分匹配进行敏感性分析，以进一步验证研究结果。
共纳入 6972 例患者（2797 例接受全膝关节置换术，4175 例接受全髋关节置换术；3690 例女性[52.9%]；平均[标准差]年龄 63.9[10.7]岁）。无 LAF 的医疗机构的 PJI 发生率与有 LAF 的医疗机构相似（0.4%[3027 例中的 12 例]与 0.5%[3945 例中的 21 例]）。在多变量逻辑回归分析中，在考虑了所有混杂因素后，使用 LAF 并未降低 PJI 的风险（调整后的优势比，0.94；95%CI，0.40-2.19；P = .89）。在倾向评分匹配后，这两个部位接受全关节置换术的患者 1 年内 PJI 的发生率无显著差异。
本研究表明，手术室中使用 LAF 并不能降低初次全关节置换术后 PJI 的发生率。在适当的预防感染围手术期方案下，LAF 似乎在预防 PJI 方面没有起到保护作用。
