Prolonged Operative Time Correlates with Increased Infection Rate After Total Knee Arthroplasty


Risk stratification has proven to be a useful tool in surgical site infection prevention. The duration of the surgical procedure has been recommended for use in surgical site infection (SSI) risk stratification (Infect Control Hosp Epidemiol 20:247–248, 1999). A retrospective analysis of 6489 patients who underwent total knee replacement (TKR) between 1993 and 1999 assessed the association between the duration of the surgical procedure and the risk of postoperative infection. One hundred thirteen infected patients were matched with 236 controls, and nominal variables were statistically processed. Patients without infections (n = 236) had surgery durations of 94 ± 28 min, and patients with infection (n = 104) had durations of 127 ± 45 min (p < 0.001). Operation time has positive correlations with weight (r = 0.3, p < 0.001), body mass index (r = 0.3, p < 0.001), and the total number of comorbidities (r = 0.2, p < 0.001; n = 340). The results confirm that the duration of the surgical procedure can be used as a risk predictor for SSI in TKR.

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  1. 1.

    C Brandt S Hansen D Sohr F Daschner H Ruden P Gastmeier (Apr 2004) ArticleTitleFinding a method for optimizing risk adjustment when comparing surgical-site infection rates Infect Control Hosp Epidemiol 25 IssueID4 313–318

    Google Scholar 

  2. 2.

    E Thomasson ParticleDe O Guingand R Terracher C Mazel (2001) ArticleTitlePerioperative complications after total hip revision surgery and their predictive factors. A series of 181 consecutive procedures Rev Chir Orthop 87 IssueID5 477–488 Occurrence Handle11547235

    PubMed  Google Scholar 

  3. 3.

    C Heisel TP Schmalzried (Aug 2003) ArticleTitleIncidence of serious complications after total hip replacement J Bone Jt Surg Am 85A IssueID8 1610–1611

    Google Scholar 

  4. 4.

    S Kessler S Kinkel W Käfer W Puhl T Schochat (2003) ArticleTitleInfluence of operation duration on the perioperative morbidity in revision total hip arthroplasty Acta Orthop Belg 69 328–33416 Occurrence Handle14526637

    PubMed  Google Scholar 

  5. 5.

    AJ Mangran TC Horan ML Pearlson LC Silver WR Jarvis (1999) ArticleTitleGuideline for prevention of surgical site infection 1999 Infect Control Hosp Epidemiol 20 247–278

    Google Scholar 

  6. 6.

    BM Patterson JR Lieberman EA Salvati (1995) ArticleTitleIntra-operative complications during total hip arthroplasty Orthopedics 18 IssueID11 1089–1095 Occurrence Handle1:STN:280:BymC2MnlsVU%3D Occurrence Handle8559694

    CAS  PubMed  Google Scholar 

  7. 7.

    G Peersman RS Laskin J Davis M Peterson (Nov 2001) ArticleTitleInfection in total knee replacement: a retrospective review of 6489 total knee replacements Clin Orthop 392 15–23

    Google Scholar 

  8. 8.

    K Saleh M Olson S Resig B Bershadsky M Kuskowski T Gioe H Robinson R Schmidt E McElfresh (2002) ArticleTitlePredictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program J Orthoptera Res 20 506–515

    Google Scholar 

  9. 9.

    J Strehle C Notaro ParticleDel R Orler B Isler (2000) ArticleTitleThe outcome of revision hip arthroplasty in patients older than age 80 years: complications and social outcome of different risk groups J Arthroplast 15 690–697 Occurrence Handle10.1054/arth.2000.7111 Occurrence Handle1:STN:280:DC%2BD3cvmsFGitA%3D%3D

    Article  CAS  Google Scholar 

  10. 10.

    F Weaver D Hynes W Hopkinson R Wixson S Khuri J Daley WG Henderson (Sep 2003) ArticleTitlePreoperative risks and outcomes of hip and knee arthroplasty in the veteran's health administration J Arthroplast 18 IssueID6 693–708 Occurrence Handle10.1016/S0883-5403(03)00259-6

    Article  Google Scholar 

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Correspondence to R. Laskin MD.

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Peersman, G., Laskin, R., Davis, J. et al. Prolonged Operative Time Correlates with Increased Infection Rate After Total Knee Arthroplasty. HSS Jrnl 2, 70–72 (2006).

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Key words

  • TKA infection
  • SSI risk stratification
  • duration of surgery