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Risk Factors for Surgical-Site Infection Following Primary Total Knee Arthroplasty

Published online by Cambridge University Press:  02 January 2015

Brian Minnema ,
Mary Vearncombe ,
Anne Augustin ,
Jeffrey Gollish  and
Andrew E. Simor
Brian Minnema
Affiliation:
Department of Microbiology and Dr. Gollish is from the Department of Surgery, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
Mary Vearncombe
Affiliation:
Department of Microbiology and Dr. Gollish is from the Department of Surgery, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Anne Augustin
Affiliation:
Department of Microbiology and Dr. Gollish is from the Department of Surgery, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
Jeffrey Gollish
Affiliation:
University of Toronto, Toronto, Ontario, Canada
Andrew E. Simor*
Affiliation:
Department of Microbiology and Dr. Gollish is from the Department of Surgery, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
*
Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, B121-2075 Bayview Avenue, Toronto, Ontario, CanadaM4N 3M5
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Abstract

Objective:

To identify risk factors associated with the development of surgical-site infection (SSI) following total knee arthroplasty (TKA).

Design:

A case-control study.

Setting:

A 1,100-bed, university-affiliated, tertiary-care teaching hospital.

Methods:

Case-patients with SSI occurring up to 1 year following primary TKA performed between January 1999 and December 2001 were identified prospectively by infection control practitioners using National Nosocomial Infections Surveillance (NNIS) System methods. Three control-patients were selected for each case-patient, matched by date of surgery. Stepwise logistic regression analysis was used to determine the relation of potential risk factors to the development of infection.

Results:

Twenty-two patients with infections (6 superficial and 16 deep) were identified. Infection rates per year were 0.95%, 1.07%, and 1.19% in 1999, 2000, and 2001, respectively. Logistic regression analysis identified two variables independently associated with the development of infection: the use of closed suction drainage (odds ratio [OR], 7.0; 95% confidence interval [CI95], 2.1-25.0; P = .0015) and increased international normalized ratio (INR) (OR, 2.4; CI95, 1.1-5.7; P = .035). Factors not statistically associated with the development of infection included age, NNIS System risk index score, presence of various comorbidities, surgeon, duration of procedure or tourniquet time, type of bone cement or prosthesis used, or receipt of blood product transfusions.

Conclusions:

The use of closed suction drainage and a high postoperative INR were associated with the development of SSI following TKA. Avoiding the use of surgical drains and careful monitoring of anticoagulant prophylaxis in patients undergoing TKA should reduce the risk of infection.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 6 , June 2004 , pp. 477 - 480
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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