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Is the risk of periprosthetic joint infection in patients undergoing total hip and knee joint arthroplasty in the multi-unit operating room higher than in the classical single-unit operating room?

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Abstract

Background

This study was performed to answer the question: Is the risk of PJI in patients undergoing primary TKA and THA in multi-unit OR higher than in a classical single-unit OR? We hypothesized that the risk of PJI following TKA and THA is not associated with the OR type.

Methods

We reviewed the medical records of all cases of THA and TKA in our centre, between January 2015 and September 2018, in our single- and multi-unit OR. A total of 8674 patients met the inclusion criteria. Patients were divided into two groups: group 1, surgery in the multi-unit OR (n = 8282); group 2, surgery in the single-unit OR (n = 450). The infection rate between both groups was compared using chi-square test.

Results

There was no significant difference between both groups regarding the septic revision rate at three (p = 0.1 and 0.58 respectively) and six months post-operatively (p = 0.22 and 0.7 respectively). In group 1, five patients after TKA and 4 patients after THA were revised within three months. At six months, 11 patients after TKA and six patients after THA required revision surgery. In group 2, one patient after TKA and one patient after THA were revised within three months. At six months, one patient after TKA and one patient after THA underwent revision surgery.

Conclusion

The incidence of SSI does not differ significantly based on OR design in patients undergoing TKA and THA. The number of patients per surgical table in multi-unit OR is higher than in the single-unit OR. This shows that more number of surgeries can be achieved in multi-unit OR and as safe as single-unit OR.

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References

  1. Laufman H (1973) Current status of special air-handling systems in operating rooms. Med Instrum 7:7–15

    CAS  PubMed  Google Scholar 

  2. Popp W, Alefelder C, Bauer S, Daeschlein G, Geistberger P, Gleich S, Herr C, Hubner NO, Jatzwauk L, Kohnen W, Kulpmann R, Lemm F, Loczenski B, Spors J, Walger P, Wehrl M, Zastrow KD, Exner M (2019) Air quality in the operating room: surgical site infections, HVAC systems and discipline - position paper of the German Society of Hospital Hygiene (DGKH). GMS Hyg Infect Control 14:Doc20. https://doi.org/10.3205/dgkh000335

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bauer H (2006) The OR as workplace: the reality and the challenge. Dtsch Arztebl 103(47): A-3185

  4. Matern U, Koneczny S, Scherrer M, Gerlings T (2006) Working conditions and safety in the operating room. Dtsch Arztebl 103(47):A3187-92

    Google Scholar 

  5. Laufman H (1971) What’s wrong with our operating rooms? Am J Surg 122:332–343. https://doi.org/10.1016/0002-9610(71)90253-4

    Article  CAS  PubMed  Google Scholar 

  6. Shaw D (1973) Is airborne infection in operating-theatres an important cause of wound infection in general surgery ? The Lancet 301:17–20. https://doi.org/10.1016/s0140-6736(73)91225-7

    Article  Google Scholar 

  7. Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36:309–332. https://doi.org/10.1016/j.ajic.2008.03.002

    Article  PubMed  Google Scholar 

  8. National Healthcare Safety Network (2022) Surgical Site Infection Event (SSI). CDC Website. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed 10 Jan 2022

  9. Urquhart DM, Hanna FS, Brennan SL, Wluka AE, Leder K, Cameron PA, Graves SE, Cicuttini FM (2010) Incidence and risk factors for deep surgical site infection after primary total hip arthroplasty: a systematic review. J Arthroplasty 25(1216–1222):e1211-1213. https://doi.org/10.1016/j.arth.2009.08.011

    Article  Google Scholar 

  10. Willis-Owen CA, Konyves A, Martin DK (2010) Factors affecting the incidence of infection in hip and knee replacement: an analysis of 5277 cases. J Bone Joint Surg Br 92:1128–1133. https://doi.org/10.1302/0301-620X.92B8.24333

    Article  CAS  PubMed  Google Scholar 

  11. Krupka DC, Sandberg WS (2006) Operating room design and its impact on operating room economics. Curr Opin Anaesthesiol 19:185–191. https://doi.org/10.1097/01.aco.0000192795.64678.e7

    Article  PubMed  Google Scholar 

  12. Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, Jiranek WA, Berry DJ (2015) Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg-Am 97:1386–1397. https://doi.org/10.2106/jbjs.N.01141

    Article  PubMed  Google Scholar 

  13. Alsved M, Civilis A, Ekolind P, Tammelin A, Andersson AE, Jakobsson J, Svensson T, Ramstorp M, Sadrizadeh S, Larsson PA, Bohgard M, Šantl-Temkiv T, Löndahl J (2018) Temperature-controlled airflow ventilation in operating rooms compared with laminar airflow and turbulent mixed airflow. J Hosp Infect 98:181–190. https://doi.org/10.1016/j.jhin.2017.10.013

    Article  CAS  PubMed  Google Scholar 

  14. Kramer A, Külpmann R, Wille F, Christiansen B, Exner M, Kohlmann T, Heidecke C, Lippert H, Oldhafer K, Schilling M, Below H, Harnoss J, Assadian O (2009) Infektiologische Bedeutung von Raumlufttechnischen Anlagen (RLTA) in Operations- und Eingriffsräumen. Zentralbl Chir 135:11–17. https://doi.org/10.1055/s-0029-1224721

    Article  PubMed  Google Scholar 

  15. Klug A, Gramlich Y, Rudert M, Drees P, Hoffmann R, Weißenberger M, Kutzner KP (2020) The projected volume of primary and revision total knee arthroplasty will place an immense burden on future health care systems over the next 30 years. Knee Surg Sports Traumatol Arthrosc 29:3287–3298. https://doi.org/10.1007/s00167-020-06154-7

    Article  PubMed  PubMed Central  Google Scholar 

  16. Schwartz AM, Farley KX, Guild GN, Bradbury TL (2020) Projections and epidemiology of revision hip and knee arthroplasty in the United States to 2030. J Arthroplasty 35:S79–S85. https://doi.org/10.1016/j.arth.2020.02.030

    Article  PubMed  PubMed Central  Google Scholar 

  17. Douglas S (2009) The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Centers for Disease Control and Prevention Website. https://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf. Accessed 15 Mar 2009

  18. Fry DE (2002) The economic costs of surgical site infection. Surg Infect (Larchmt) 3(Suppl 1):S37-43. https://doi.org/10.1089/sur.2002.3.s1-37

    Article  Google Scholar 

  19. Urban JA (2006) Cost analysis of surgical site infections. Surg Infect (Larchmt) 7(Suppl 1):S19-22. https://doi.org/10.1089/sur.2006.7.s1-19

    Article  Google Scholar 

  20. Barie PS, Eachempati SR (2005) Surgical site infections. Surg Clin North Am 85:1115–1135. https://doi.org/10.1016/j.suc.2005.09.006 (viii-ix)

    Article  PubMed  Google Scholar 

  21. Allo MD, Tedesco M (2005) Operating room management: operative suite considerations, infection control. Surg Clin North Am 85(1291–1297):xii. https://doi.org/10.1016/j.suc.2005.09.001

    Article  Google Scholar 

  22. Salassa TE, Swiontkowski MF (2014) Surgical attire and the operating room: role in infection prevention. J Bone Joint Surg Am 96:1485–1492. https://doi.org/10.2106/JBJS.M.01133

    Article  PubMed  Google Scholar 

  23. Letts RM, Doermer E (1983) Conversation in the operating theater as a cause of airborne bacterial contamination. J Bone Joint Surg Am 65:357–362

    Article  CAS  Google Scholar 

  24. Babkin Y, Raveh D, Lifschitz M, Itzchaki M, Wiener-Well Y, Kopuit P, Jerassy Z, Yinnon AM (2007) Incidence and risk factors for surgical infection after total knee replacement. Scand J Infect Dis 39:890–895. https://doi.org/10.1080/00365540701387056

    Article  PubMed  Google Scholar 

  25. Scaltriti S, Cencetti S, Rovesti S, Marchesi I, Bargellini A, Borella P (2007) Risk factors for particulate and microbial contamination of air in operating theatres. J Hosp Infect 66:320–326. https://doi.org/10.1016/j.jhin.2007.05.019

    Article  CAS  PubMed  Google Scholar 

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Author notes

  1. Salahulddin Abuljadail and Mustafa Akkaya contributed equally in writing this article.

Authors and Affiliations

  1. Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany

    Salahulddin Abuljadail, Mustafa Akkaya, Rudy Sangaletti, Thorsten Gehrke & Mustafa Citak

  2. Department of Orthopaedic Surgery, Southland Teaching Hospital, Invercargill, New Zealand

    Nemandra Sandiford

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  1. Salahulddin Abuljadail
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  2. Mustafa Akkaya
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  4. Nemandra Sandiford
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  5. Thorsten Gehrke
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  6. Mustafa Citak
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Salahulddin Abuljadail, Mustafa Akkaya, and Rudy Sangaletti. The first draft of the manuscript was written by Salahulddin Abuljadail and Mustafa Akkaya and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mustafa Citak.

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Ethics approval

This study was performed after obtaining an ethical approval. Approval was granted by the Ethics Committee of Hamburg Medical Council (Approval Number: 2021–300109-WF).

Competing interests

The authors declare no competing interests.

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Abuljadail, S., Akkaya, M., Sangaletti, R. et al. Is the risk of periprosthetic joint infection in patients undergoing total hip and knee joint arthroplasty in the multi-unit operating room higher than in the classical single-unit operating room?. International Orthopaedics (SICOT) 46, 1465–1471 (2022). https://doi.org/10.1007/s00264-022-05391-4

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