title: The Use of Routine Postoperative Microscopy and Culture Screening Following Elective Hip and Knee Arthroplasty: An Unnecessary Cost With No Effect on Clinical Management?
abstract: The use of microscopy and culture screening to detect pathogenic microorganisms followed by a decolonization protocol is a widely performed practice prior to elective hip and knee arthroplasty. In our center, the routine care of hip and knee arthroplasty also involves postoperative screening including direct culture of the surgical site. The aim of this study was to assess the frequency of pathogen detection following these tests and to determine whether routine postoperative screening, with particular reference to postoperative surgical site culture, led to any change in clinical management of these patients.
  
  
  
  A series of 1000 patients undergoing hip or knee arthroplasty at The Mater Hospital between January 2014 and December 2015 were identified from our arthroplasty database. Results of preoperative and postoperative microscopy and culture screening were reviewed by 2 independent researchers.
  
  
  
  Of the 1000 subjects, positive microscopy and culture results were identified in 88 patients (8.8%) preoperatively and 5 patients (0.5%) postoperatively. None of the 1000 postoperative surgical site swabs had a positive microscopy and culture screen. All the 5 positive postoperative microscopy and culture screen results were in patients who had positive cultures preoperatively. There were no positive postoperative microscopy and culture screen results in patients who had had negative preoperative results. Postoperative screening was performed at a cost of AUS$213 per patient.
  
  
  
  Routine postoperative surgical site culture following hip and knee arthroplasty does not alter clinical management, has a significant associated financial cost, and has the potential to expose the patient to a risk of surgical site infection and is therefore not supported.
authors.affiliation: North Sydney Orthopaedic and Sports Medicine Centre, The Mater Hospital, Wollstonecraft, New South Wales, Australia.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Kemp
authors.affiliation: North Sydney Orthopaedic and Sports Medicine Centre, The Mater Hospital, Wollstonecraft, New South Wales, Australia.
authors.forename: Ka
authors.initials: K
authors.lastname: Martina
authors.affiliation: North Sydney Orthopaedic and Sports Medicine Centre, The Mater Hospital, Wollstonecraft, New South Wales, Australia.
authors.forename: Claire L
authors.initials: CL
authors.lastname: Collins
authors.affiliation: North Sydney Orthopaedic and Sports Medicine Centre, The Mater Hospital, Wollstonecraft, New South Wales, Australia.
authors.forename: Lucy J
authors.initials: LJ
authors.lastname: Salmon
authors.affiliation: North Sydney Orthopaedic and Sports Medicine Centre, The Mater Hospital, Wollstonecraft, New South Wales, Australia.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Gooden
authors.affiliation: North Sydney Orthopaedic and Sports Medicine Centre, The Mater Hospital, Wollstonecraft, New South Wales, Australia.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Lyons
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001431:Bacteriological Techniques / Q000191:economics*; D017558:Elective Surgical Procedures / Q000191:economics*; D006801:Humans; D008828:Microbiological Techniques / Q000191:economics; D008853:Microscopy / Q000191:economics; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*; D019564:Unnecessary Procedures / Q000191:economics*
keywords: culture screen; hip/knee arthroplasty; methicillin-resistant Staphylococcus aureus; surgical site; wound swabs