Does Preoperative Air Travel Increase Infection Risk After Total Knee Arthroplasty? A Propensity-Matched Analysis

Area of Science:

• Orthopedic Surgery
• Infectious Disease Epidemiology
• Patient Safety

Background:

• Periprosthetic joint infection (PJI) is a severe complication of total knee arthroplasty (TKA), leading to significant morbidity and healthcare costs.
• While air travel is linked to venous thromboembolism, its association with infection risk following TKA remains unclear.

Purpose of the Study:

• To investigate the association between preoperative air travel and the risk of PJI, superficial surgical site infection (SSI), and septicemia after TKA.
• To compare infectious outcomes in patients who likely traveled by air versus those who likely traveled by land before undergoing elective TKA.

Main Methods:

• Retrospective cohort study utilizing a large patient database.
• Propensity score matching to create comparable groups of 'likely air travel' and 'likely land travel' patients (11,866 each).
• Analysis of PJI, SSI, and septicemia rates using odds ratios and 95% confidence intervals.

Main Results:

• No significant differences in PJI rates at 90 days (0.5% vs. 0.5%) or two years (1.0% vs. 1.0%) between air and land travel groups.
• Similar rates of superficial SSI at 30 and 90 days, and rare occurrences of septicemia in both cohorts.
• Multivariable regressions and subgroup analyses confirmed no increased infectious risk associated with preoperative air travel.

Conclusions:

• Preoperative air travel is not associated with an elevated risk of PJI, superficial SSI, or systemic infection after elective TKA.
• Further research is warranted to explore potential differences in outcomes for international travel due to varying pathogen exposure and infection control practices.