title: Procrastination of wound drainage and malnutrition affect the outcome of joint arthroplasty.
abstract: The association between wound drainage and subsequent periprosthetic infection is well known. However, the most appropriate treatment of wound drainage is not well understood. We retrospectively reviewed the records of 10,325 patients (11,785 procedures), among whom 300 patients (2.9%) developed persistent (greater than 48 hours postoperatively) wound drainage. Wound drainage stopped spontaneously between 2 and 4 days in 217 patients treated with local wound care and oral antibiotics. The remaining 83 patients (28%) underwent further surgery. A single débridement resulted in cessation of drainage without subsequent infection in 63 of 83 patients (76%), whereas 20 (24%) patients continued to drain and underwent additional treatment (repeat débridement, resection arthroplasty, or long-term antibiotics). Timing of surgery and the presence of malnutrition predicted failure of the first débridement. There were no differences between the success and failure groups with regard to all other examined parameters, including demographic or surgical factors.
  
  
  METHODS
  Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Rothman Institute of Orthopedics, Thomas Jefferson Hospital, 925 Chestnut Street, Philadelphia, PA 19107, USA.
authors.forename: Fereidoon M
authors.initials: FM
authors.lastname: Jaberi
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
authors.forename: C Thomas
authors.initials: CT
authors.lastname: Haytmanek
authors.forename: Ashish
authors.initials: A
authors.lastname: Joshi
authors.forename: James
authors.initials: J
authors.lastname: Purtill
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015331:Cohort Studies; D003646:Debridement; D005122:Exudates and Transudates; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000150:complications / Q000601:surgery*; D008297:Male; D044342:Malnutrition / Q000150:complications*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology* / Q000628:therapy; D013997:Time Factors; D017211:Treatment Failure