title: Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures.
abstract: OBJECTIVE
  To determine the association (1) between shorter operative duration and surgical site infection (SSI) and (2) between surgeon median operative duration and SSI risk among first-time hip and knee arthroplasties.
  
  
  METHODS
  Retrospective cohort study
  
  
  METHODS
  A total of 43 community hospitals located in the southeastern United States.
  
  
  METHODS
  Adults who developed SSIs according to National Healthcare Safety Network criteria within 365 days of first-time knee or hip arthroplasties performed between January 1, 2008 and December 31, 2012.
  
  
  METHODS
  Log-binomial regression models estimated the association (1) between operative duration and SSI outcome and (2) between surgeon median operative duration and SSI outcome. Hip and knee arthroplasties were evaluated in separate models. Each model was adjusted for American Society of Anesthesiology score and patient age.
  
  
  RESULTS
  A total of 25,531 hip arthroplasties and 42,187 knee arthroplasties were included in the study. The risk of SSI in knee arthroplasties with an operative duration shorter than the 25th percentile was 0.40 times the risk of SSI in knee arthroplasties with an operative duration between the 25th and 75th percentile (risk ratio [RR], 0.40; 95% confidence interval [CI], 0.38-0.56; P<.01). Short operative duration did not demonstrate significant association with SSI for hip arthroplasties (RR, 1.04; 95% CI, 0.79-1.37; P=.36). Knee arthroplasty surgeons with shorter median operative durations had a lower risk of SSI than surgeons with typical median operative durations (RR, 0.52; 95% CI, 0.43-0.64; P<.01).
  
  
  CONCLUSIONS
  Short operative durations were not associated with a higher SSI risk for knee or hip arthroplasty procedures in our analysis.
authors.affiliation: 1Department of Medicine,Division of Infectious Diseases,Duke University Medical Center,Durham,North Carolina.
authors.forename: Kristen V
authors.initials: KV
authors.lastname: Dicks
authors.affiliation: 1Department of Medicine,Division of Infectious Diseases,Duke University Medical Center,Durham,North Carolina.
authors.forename: Arthur W
authors.initials: AW
authors.lastname: Baker
authors.affiliation: 1Department of Medicine,Division of Infectious Diseases,Duke University Medical Center,Durham,North Carolina.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Durkin
authors.affiliation: 1Department of Medicine,Division of Infectious Diseases,Duke University Medical Center,Durham,North Carolina.
authors.forename: Deverick J
authors.initials: DJ
authors.lastname: Anderson
authors.affiliation: 1Department of Medicine,Division of Infectious Diseases,Duke University Medical Center,Durham,North Carolina.
authors.forename: Rebekah W
authors.initials: RW
authors.lastname: Moehring
authors.affiliation: 1Department of Medicine,Division of Infectious Diseases,Duke University Medical Center,Durham,North Carolina.
authors.forename: Luke F
authors.initials: LF
authors.lastname: Chen
authors.affiliation: 1Department of Medicine,Division of Infectious Diseases,Duke University Medical Center,Durham,North Carolina.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sexton
authors.affiliation: 4Department of Medicine,Division of Infectious Diseases,University of North Carolina School of Medicine,Chapel Hill,North Carolina.
authors.forename: David J
authors.initials: DJ
authors.lastname: Weber
authors.affiliation: 1Department of Medicine,Division of Infectious Diseases,Duke University Medical Center,Durham,North Carolina.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Lewis
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015144:Southeastern United States / Q000453:epidemiology; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology*; D013997:Time Factors