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Comparison of Operating Room Air Quality in Primary Versus Revision Total Knee Arthroplasty
Chelsea Sue Sicat1, Ran Schwarzkopf1, James D Slover1
1Department of Orthopedic Surgery, NYU Langone Health, New York, NY.
Background:
Airborne biologic particles (ABPs) can be measured intraoperatively to evaluate operating room (OR) sterility. Particulate matter (PM) up to 2.5 microns can contain microbial species which may increase infection risk. Our study examines the differences in air quality and ABP count in primary total knee arthroplasty (TKA) and revision TKA (rTKA).
Methods:
We analyzed primary and rTKAs in a single OR at an academic institution from January 2020 to December 2020. Procedures from March 15, 2020, to May 4, 2020, were excluded to avoid COVID-related confounding. Temperature, humidity, and ABP count per minute were recorded with a particle counter intraoperatively and cross-referenced with surgical data from the electronic health records using procedure start and end times. Descriptive statistics were used to evaluate the differences in variables. P values were calculated using t-test and chi-square test.
Results:
A total of 107 TKA cases were included: 79 (73.8%) primary TKAs and 28 (26.2%) rTKAs. Time spent in an OR was significantly higher for rTKAs (primary: 176 ± 46.7 minutes vs revision: 220 ± 47.1 minutes, P < .0001). Compared to primary TKAs, rTKAs had significant percent increases in ABP rates for particles measuring 0.3 μm (+70.4%, P < .001), 0.5 μm (+97.2%, P < .0001), 1.0 μm (+53.2%, P = .001), and 2.5 μm (+30.3%, P = .017) and for PM 2.5 (+108.3%, P < .001) and PM 5.0 (+105.6%, P < .001).
Conclusion:
rTKAs had significantly longer time spent in an OR and significant percent increases in ABP rates for particles measuring 0.3 μm, 0.5 μm, and 1.0 μm compared to primary TKAs. Measurements of PM 2.5 and 5.0 (which can contain large numbers of microbes) were also significantly greater in rTKAs. Further research is needed to determine whether the size and quantity of ABPs translate to higher infection rates after rTKA.
Insights
Revision total knee arthroplasty (TKA) procedures have higher airborne biologic particle (ABP) counts and particulate matter (PM) levels compared to primary TKAs, potentially impacting operating room sterility and infection risk.
Area of Science:
- Orthopedic Surgery
- Environmental Microbiology
- Healthcare Epidemiology
Background:
- Airborne biologic particles (ABPs) are key indicators of operating room (OR) sterility.
- Particulate matter (PM) ≤ 2.5 microns can harbor microbes, increasing infection risk.
- Comparing air quality in primary total knee arthroplasty (TKA) versus revision TKA (rTKA) is crucial for infection control.
Purpose of the Study:
- To investigate differences in airborne biologic particle (ABP) counts and air quality between primary total knee arthroplasty (TKA) and revision TKA (rTKA) procedures.
- To assess the correlation between procedure type and intraoperative environmental contamination.
- To identify potential risk factors for surgical site infections in TKA procedures.
Main Methods:
- Intraoperative monitoring of temperature, humidity, and ABP counts using a particle counter.
- Analysis of 107 TKA cases (79 primary, 28 revision) from January to December 2020, excluding March-May 2020 for COVID-19 confounding.
- Cross-referencing ABP data with electronic health records and statistical analysis (t-test, chi-square) to compare variables.
Main Results:
- Revision TKAs (rTKAs) had significantly longer operating room (OR) times (220 ± 47.1 min) compared to primary TKAs (176 ± 46.7 min).
- rTKAs showed significant increases in ABP rates for particles of 0.3 μm (+70.4%), 0.5 μm (+97.2%), and 1.0 μm (+53.2%).
- rTKAs also had higher levels of PM 2.5 (+108.3%) and PM 5.0 (+105.6%) compared to primary TKAs.
Conclusions:
- Revision TKA procedures are associated with increased airborne biologic particle (ABP) levels and particulate matter (PM) compared to primary TKAs.
- Longer intraoperative times in rTKAs may contribute to higher environmental contamination.
- Further research is needed to determine if elevated ABP levels in rTKAs correlate with increased surgical site infection rates.
