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Does Operative Time Affect Infection Rate in Primary Total Knee Arthroplasty?

  • Symposium: 2014 Knee Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Prolonged operative time may increase the risk of infection after total knee arthroplasty (TKA). Both surgeon-related and patient-related factors can contribute to increased operative times.

Questions/purposes

The purpose of this study was to determine (1) whether increased operative time is an independent risk factor for revision resulting from infection after TKA; (2) whether increasing body mass index (BMI) increased operative time; and (3) whether increasing experience substantially decreased operative time.

Methods

We retrospectively evaluated primary TKAs from our joint registry between March 2000 and August 2012. Cox proportional hazard models were used to assess the relationship between operative time and revision resulting from infection after accounting for age, sex, BMI, and Agency for Healthcare Research and Quality comorbidity score. Of 9973 instances of primary TKA, 73 underwent revision surgery for infection (0.73%).

Results

After accounting for the confounders of age and sex, operative time was not found to have a significant effect; a 15-minute increase in operative time increased the hazard of revision resulting from infection by only 15.6% (p = 0.053; 95% confidence interval, 0.0%–34.0%). In addition, a five-unit increase in BMI was found to increase mean operative time by 1.9 minutes, on average, regardless of sex (p < 0.0001). Operative time decreases with increasing experience but appears to plateau at approximately 300 surgeries.

Conclusions

Operative time is only one of many factors that may increase infection risk and may be influenced by numerous confounders. Increasing BMI increased operative time but the effect was modest. The effect of increasing experience on operative duration of this common procedure was surprisingly limited among our surgeons.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA

    Sameer Naranje MD & Terence J. Gioe MD

  2. HealthEast Department of Research, St Paul, MN, USA

    Lisa Lendway PhD & Susan Mehle BS

  3. Minneapolis Veterans Administration Health Care System, Section 112E, 1 Veterans Drive, Minneapolis, MN, 55417, USA

    Terence J. Gioe MD

Authors
  1. Sameer Naranje MD
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  2. Lisa Lendway PhD
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  3. Susan Mehle BS
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  4. Terence J. Gioe MD
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Corresponding author

Correspondence to Terence J. Gioe MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at HealthEast Hospitals, St Paul, MN, USA.

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Naranje, S., Lendway, L., Mehle, S. et al. Does Operative Time Affect Infection Rate in Primary Total Knee Arthroplasty?. Clin Orthop Relat Res 473, 64–69 (2015). https://doi.org/10.1007/s11999-014-3628-4

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  • DOI: https://doi.org/10.1007/s11999-014-3628-4

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