Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 8/2018

01-08-2018 | Reports of Original Investigations

Suspected periprosthetic joint infection after total knee arthroplasty under propofol versus sevoflurane anesthesia: a retrospective cohort study

Authors: Miwa Kishimoto, MD, Hayato Yamana, MD, MPH, Satoki Inoue, MD, PhD, Tatsuya Noda, MD, PhD, Manabu Akahane, MD, PhD, Yusuke Inagaki, MD, PhD, Hiroki Matsui, MPH, Hideo Yasunaga, MD, PhD, Masahiko Kawaguchi, MD, PhD, Tomoaki Imamura, MD, PhD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 8/2018

Login to get access

Abstract

Purpose

Periprosthetic joint infection is a serious complication of total knee arthroplasty. Though there are many factors that might increase its risk, the use of propofol for maintaining general anesthesia could theoretically increase the incidence of infection because of its lipid component that supports bacterial growth. Nevertheless, the relationship between anesthetic maintenance agents and the occurrence of periprosthetic joint infection remains uncertain. The purpose of this study was to compare the incidence of suspected early-onset periprosthetic joint infection between patients undergoing total knee arthroplasty under propofol vs sevoflurane anesthesia.

Methods

We conducted a retrospective cohort study of patients in the national inpatient Diagnosis Procedure Combination database in Japan who underwent total knee arthroplasty. Suspected periprosthetic joint infection was surrogately defined as the need for arthrocentesis or debridement within 30 days of surgery. Propensity score matching was performed between patients who received either propofol or sevoflurane for anesthetic maintenance to determine the proportion of those with infection.

Results

Eligible patients (n = 21,899) were categorized into either the propofol (n = 7,439) or sevoflurane (n = 14,460) groups. In the 5,140 propensity-matched patient pairs, there was no significant difference in the proportion of arthrocentesis or debridement [1.3% propofol vs 1.7% sevoflurane; respectively (relative risk, 0.76; 95% CI, 0.55 to 1.04; P = 0.10)] between the groups. The mean (SD) length of stay in the propofol group was significantly longer than in the sevoflurane group [32.5 (18.4) days vs 31.4 (14.4) days, respectively; mean difference, 1.1; 95% CI, 0.5 to 1.8; P < 0.001].

Conclusion

Propensity score analysis suggested no significant association between the choice of anesthetic maintenance agent and the occurrence of suspected early-onset periprosthetic joint infection in patients undergoing total knee arthroplasty.
Literature
1.
Pugely AJ, Martin CT, Gao Y, Schweizer ML, Callaghan JJ. The incidence of and risk factors for 30-day surgical site infections following primary and revision total joint arthroplasty. J Arthroplasty 2015; 30: 47-50.CrossRefPubMed
2.
Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res 2010; 468: 52-6.CrossRefPubMed
3.
Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am 2013; 95: 775-82.CrossRefPubMed
4.
Zmistowski B, Karam JA, Durinka JB, Casper DS, Parvizi J. Periprosthetic joint infection increases the risk of one-year mortality. J Bone Joint Surg Am 2013; 95: 2177-84.CrossRefPubMed
5.
Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012; 27(61-5): e1.
6.
Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvisi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty 2008; 23: 984-91.CrossRefPubMed
7.
Korol E, Johnston K, Waser N, et al. A systematic review of risk factors associated with surgical site infections among surgical patients. PloS One 2013; 8: e83743.CrossRefPubMedPubMedCentral
8.
9.
Chang CC, Lin HC, Lin HW, Lin HC. Anesthetic management and surgical site infections in total hip or knee replacement: a population-based study. Anesthesiology 2010; 113: 279-84.CrossRefPubMed
10.
Bennett SN, McNeil MM, Bland LA, et al. Postoperative infections traced to contamination of an intravenous anesthetic, propofol. N Engl J Med 1995; 333: 147-54.CrossRefPubMed
11.
Zorrilla-Vaca A, Arevalo JJ, Escandón-Vargas K, Soltanifar D, Mirski MA. Infectious disease risk associated with contaminated propofol anesthesia, 1989-2014. Emerg Infect Dis 2016; 22: 981-92.CrossRefPubMedPubMedCentral
12.
13.
Chen RM, Chen TG, Chen TL, et al. Anti-inflammatory and antioxidative effects of propofol on lipopolysaccharide-activated macrophages. Ann N Y Acad Sci 2005; 1042: 262-71.CrossRefPubMed
14.
Shimizu K, Hirose M, Mikami S, et al. Effect of anaesthesia maintained with sevoflurane and propofol on surgical site infection after elective open gastrointestinal surgery. J Hosp Infect 2010; 74: 129-36.CrossRefPubMed
15.
Koo BW, Sim JB, Shin HJ, et al. Surgical site infection after colorectal surgery according to the main anesthetic agent: a retrospective comparison between volatile anesthetics and propofol. Korean J Anesthesiol 2016; 69: 332-40.CrossRefPubMedPubMedCentral
16.
Jerath A, Panckhurst J, Parotto M, et al. Safety and efficacy of volatile anesthetic agents compared with standard intravenous midazolam/propofol sedation in ventilated critical care patients: a meta-analysis and systematic review of prospective trials. Anesth Analg 2076; 124: 1190-9.
17.
Yasunaga H, Matsui H, Horiguchi H, Fushimi K, Matsuda S. Clinical epidemiology and health services research using the diagnosis procedure combination database in Japan. Asian Pac J Dis Manage 2013; 7: 19-24.
18.
Brinkman GL, Coates EO Jr. The effect of bronchitis, smoking, and occupation on ventilation. Am Rev Respir Dis 1963; 87: 684-93.PubMed
19.
Hashimoto H, Ikegami N, Shibuya K, et al. Cost containment and quality of care in Japan: is there a trade-off? Lancet 2011; 378: 1174-82.CrossRefPubMed
20.
21.
22.
Austin PC. Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research. Commun Stat Simul Comput 2009; 38: 1228-34.CrossRef
23.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999; 27: 97-134
24.
Walker LC, Baker P, Holleyman R, Deehan D. Microbial resistance related to antibiotic-loaded bone cement: a historical review. Knee Surg Sports Traumatol Arthrosc 2017; 25: 3808-17.CrossRefPubMed
25.
Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2012; 56: e1-25.CrossRefPubMed
26.
Parvizi J, Gehrke T, Chen AF. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J 2013; 95: 1450-2.CrossRefPubMed
27.
Kapadia BH, Berg RA, Daley JA, Fritz J, Bhave A, Mont MA. Periprosthetic joint infection. Lancet 2016; 387: 386-94.CrossRefPubMed
28.
29.
Griswold ME, Localio AR, Mulrow C. Propensity score adjustment with multilevel data: setting your sites on decreasing selection bias. Ann Internal Med 2010; 152: 393-5.CrossRef
30.
Rosenbaum PR, Rubin DB. Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat 1985; 39: 33-8.
31.
Yasunaga H, Tsuchiya K, Matsuyama Y, Ohe K. Analysis of factors affecting operating time, postoperative complications, and length of stay for total knee arthroplasty: nationwide web-based survey. J Orthop Sci 2009; 14: 10-6.CrossRefPubMed
32.
Ishii Y, Noguchi H, Takeda M, Sato J, Suzuki T. Length of hospital stay with patient-dependent determination in bilateral scheduled staged total knee arthroplasty. Eur J Orthop Surg Traumatol 2014; 24: 961-5.CrossRefPubMed
33.
Metadata
Title
Suspected periprosthetic joint infection after total knee arthroplasty under propofol versus sevoflurane anesthesia: a retrospective cohort study
Authors
Miwa Kishimoto, MD
Hayato Yamana, MD, MPH
Satoki Inoue, MD, PhD
Tatsuya Noda, MD, PhD
Manabu Akahane, MD, PhD
Yusuke Inagaki, MD, PhD
Hiroki Matsui, MPH
Hideo Yasunaga, MD, PhD
Masahiko Kawaguchi, MD, PhD
Tomoaki Imamura, MD, PhD
Publication date
01-08-2018
Publisher
Springer US
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 8/2018
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-018-1139-6

Other articles of this Issue 8/2018

Canadian Journal of Anesthesia/Journal canadien d'anesthésie 8/2018 Go to the issue

Obituary

Dr. Arthur A. Scott

Reports of Original Investigations

Primary central sleep apnea and anesthesia: a retrospective case series

Editorials

Ethical dilemmas in global anesthesia and surgery

Review Article/Brief Review

Does apneic oxygenation prevent desaturation during emergency airway management? A systematic review and meta-analysis

Images in Anesthesia

Wesley Bourne: leader extraordinaire of Canadian anesthesiology

In reply

In reply to “Because it’s 2018: Women in Canadian Anesthesiology”