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


METHODS
A case-control study.


METHODS
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.
Minnema
Brian
B
Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
Vearncombe
Mary
M
Augustin
Anne
A
Gollish
Jeffrey
J
Simor
Andrew E
AE
D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D000925:Anticoagulants / Q000494:pharmacology* / Q000592:standards; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001424:Bacterial Infections / Q000453:epidemiology* / Q000517:prevention & control; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D019934:International Normalized Ratio / Q000592:standards*; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011292:Premedication; D012307:Risk Factors; D018571:Sentinel Surveillance; D013396:Suction / Q000009:adverse effects* / Q000706:statistics & numerical data; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D013997:Time Factors
D000925:Anticoagulants