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Analysis of the effects of intraoperative warming devices on surgical site infection in elective hip arthroplasty using a large nationwide database

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The aim of our study is to analyze the association of usage and type of warming device with the risk of surgical site infection (SSI) in patients who underwent hip arthroplasty, and to analyze the factors that increase the risk of SSI if the warming device is not used.

Materials and methods

This retrospective cross-sectional study identified subjects from data of “Evaluation of the Appropriate Use of Prophylactic Antibiotics”. Included patients were defined as those who underwent elective unilateral hip hemiarthroplasty or total hip arthroplasty (THA). Patients were classified into no intraoperative warming device, forced air warming devices, and devices using conduction. Multiple logistic regression analysis was conducted to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to assess the association between warming devices and SSI.

Results

A total of 3945 patients met the inclusion criteria. Compared to those who received an intraoperative warming device, the odds of developing SSI were 1.9 times higher in those who did not receive intraoperative warming devices (aOR 1.9; 95% CI 1.1–3.6). The risk of SSI was 2.2 times higher with forced air warming devices compared to devices using conduction but this difference was not statistically significant (aOR 2.2; 95% CI 0.7–6.8). The risk of SSI increased in males (aOR 2.8; 95% CI 1.1–7.2), in patients under 70 years of age (aOR 4.4; 95% CI 1.6–10.4), in patients with a Charlson`s comorbidity index of 2 or higher (aOR 3.3; 95% CI 1.3–8.7), and in patients who underwent THA (aOR 3.8; 95% CI 1.7–8.3) when intraoperative warming devices were not used.

Conclusions

The use of intraoperative active warming devices is highly recommended to prevent SSI during elective hip arthroplasty. In particular, male patients younger than 70 years, those with a high CCI, and those undergoing THA are at significantly increased risk of SSI if intraoperative active warming devices are not used. Intraoperative warming device using conduction is likely superior to forced air warming device, but further studies are needed to confirm this.

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Data availability

The data utilized in our research is managed by government and cannot be disclosed to third parties in accordance with their policies.

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Acknowledgements

This study was conducted as a Joint Project on Quality Assessment Research of Health Insurance Review & Assessment Service. This study was based on data from the HIRA (research data number: M20220219833).

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Authors and Affiliations

  1. Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, South Korea

    Seung Hoon Kim

  2. Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea

    Suk-Yong Jang

  3. Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, 95 Dunsan Seoro, Seo-Gu, Daejeon, 35233, South Korea

    Yonghan Cha

  4. Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, South Korea

    Bo-Yeon Kim

  5. Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju, South Korea

    Hyo-Jung Lee & Gui-Ok Kim

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  1. Seung Hoon Kim
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Correspondence to Yonghan Cha.

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The study design and protocol were approved by the institutional review board of the Eulji University Hospital (EMC-IRB 2023-01-003).

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Written informed consent was waived due to the nature of the retrospective study.

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Kim, S.H., Jang, SY., Cha, Y. et al. Analysis of the effects of intraoperative warming devices on surgical site infection in elective hip arthroplasty using a large nationwide database. Arch Orthop Trauma Surg 143, 7237–7244 (2023). https://doi.org/10.1007/s00402-023-04917-8

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  • DOI: https://doi.org/10.1007/s00402-023-04917-8

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