Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Int Orthop. 2024 Nov;48(11):2793-2799. doi: 10.1007/s00264-024-06317-y. Epub 2024 Sep 17.
The potential influence of surgical sequence of elective hip-and-knee reconstructive surgery in relation to an infection-related procedure on postoperative infection rates is not clearly understood. Therefore, we aimed to examine the impact of surgical sequence on the incidence of postoperative infections within one-year and the longest available follow-up period in patients undergoing hip-and-knee reconstructive surgery.
A case-control study with propensity matching was utilized to examine elective surgeries conducted at Sunnybrook Holland Orthopaedic & Arthritic centre, Toronto, Canada between 2015 and 2018. We determined and categorized them based on their operating room (OR) sequence in relation to an infected case; the cases were those performed right after (post-infection cohort), and the controls were those performed before an infection-related procedure in the same OR (pre-infection cohort). We employed survival analysis to compare the infection incidence within one year and at the longest available follow-up among the propensity-matched cohort.
A total of 13,651 cases were identified during the four year period. We successfully matched 153 cases (21 post-infection and 132 pre-infection) using propensity scores. Demographic and clinical characteristics were balanced through matching. Kaplan-Meier survival analysis showed no significant difference in infection-free survival within one year and at a median follow-up of 2.2 years [interquartile range 0.9-5.0] between surgeries conducted before and after infected cases (both log-rank p-values = 0.4). The hazard ratios for infection within one year and the longest follow-up period were both 0.37 [95%Confidence Interval 0.03-4.09, p = 0.418], as no more events occurred after one year.
The sequence of surgical procedures, whether or not an elective arthroplasty or lower limb reconstructive procedure occurs before or after an infection-related case in the same OR, does not significantly affect postoperative infection rates. This finding supports the efficacy of the current infection control measures and suggests a reconsideration of surgical scheduling standards.
择期髋关节和膝关节重建手术中与感染相关手术的手术顺序对术后感染率的潜在影响尚不清楚。因此，我们旨在研究手术顺序对髋关节和膝关节重建手术后一年内及最长可随访期间患者术后感染发生率的影响。
采用病例对照研究和倾向评分匹配，分析 2015 年至 2018 年在加拿大多伦多桑尼布鲁克荷兰骨科和关节炎中心进行的择期手术。我们根据手术在手术室（OR）中的顺序对其进行了确定和分类，与感染病例相关；病例是在感染后立即进行的（感染后队列），对照组是在同一 OR 中进行感染相关手术之前进行的（感染前队列）。我们采用生存分析比较了倾向匹配队列中一年内和最长可随访期间的感染发生率。
在四年期间共确定了 13651 例病例。我们成功地使用倾向评分匹配了 153 例病例（21 例感染后和 132 例感染前）。通过匹配使人口统计学和临床特征平衡。Kaplan-Meier 生存分析显示，在感染后一年内和中位数为 2.2 年（四分位距 0.9-5.0）的随访中，在感染病例前后进行的手术之间，无感染生存率无显著差异（两种情况的对数秩 p 值均为 0.4）。感染后一年内和最长随访期内的感染风险比均为 0.37 [95%置信区间 0.03-4.09，p=0.418]，因为在一年后没有更多的事件发生。
手术顺序，无论是否在同一 OR 中进行感染相关病例前后进行择期关节置换术或下肢重建手术，均不会显著影响术后感染率。这一发现支持当前感染控制措施的有效性，并提示重新考虑手术安排标准。
