Vet Comp Orthop Traumatol 2015; 28(03): 199-206
DOI: 10.3415/VCOT-14-09-0141
Original Research
Schattauer GmbH

Perioperative risk factors for surgical site infection in tibial tuberosity advancement: 224 stifles

F. W. Yap
1   Small Animal Hospital, Faculty of Veterinary Medicine, University of Glasgow, United Kingdom
,
I. Calvo
1   Small Animal Hospital, Faculty of Veterinary Medicine, University of Glasgow, United Kingdom
,
K.D. Smith
1   Small Animal Hospital, Faculty of Veterinary Medicine, University of Glasgow, United Kingdom
,
T. Parkin
1   Small Animal Hospital, Faculty of Veterinary Medicine, University of Glasgow, United Kingdom
› Author Affiliations
Further Information

Publication History

Received: 14 September 2014

Accepted: 12 February 2018

Publication Date:
24 October 2018 (online)

Summary

Objective: To examine perioperative factors affecting surgical site infection (SSI) rate following tibial tuberosity advancement (TTA).

Study design: Retrospective case series.

Sample population: 224 stifles in 186 dogs.

Methods: Medical records of dogs that underwent TTA in a single institution were reviewed. Information on signalment anaesthetic and surgical parameters, as well as occurrence of SSI was recorded. Dogs were followed for a minimum of three months postoperatively. The association between perioperative factors and SSI was assessed using

Chi-squared tests and binary logistic regression.

Results: The prevalence of SSI was 5.3% (12/224 TTA). Surgical time (p = 0.02) and anaesthesia time (p = 0.03) were significantly associated with SSI. For every minute increase in surgical time and anaesthesia time, the likelihood of developing SSI increased by seven percent and four percent respectively. The use of postoperative antimicrobial therapy was not significantly associated with lower SSI (p = 0.719). Implants were removed in 1.3% of cases (3/224 TTA).

Conclusions: The findings of this study suggest that increased surgical and anaesthesia times are significant risk factors for SSI in TTA, and that there is no evidence that postoperative prophylactic antimicrobial therapy is associated with SSI rate.

 
  • References

  • 1 Tirgari M. Changes in canine stifle joint following rupture of anterior cruciate ligament. J Small Anim Pract 1978; 19: 17-26.
  • 2 Innes JF, Barr ARS. Clinical natural history of the postsurgical cruciate deficient canine stifle joint: year 1. J Small Anim Pract 1998; 39: 325-332.
  • 3 Comerford EJ, Smith K, Hayashi K. Update on the aetiopathogenesis of canine cranial cruciate ligament disease. Vet Comp Orthop Traumatol 2011; 24: 91-98.
  • 4 Deangeli M, Lau RE. A lateral retinacular imbrication technique for surgical correction of anterior cruciate ligament rupture in dog. J Am Vet Med Assoc 1970; 157: 79-84.
  • 5 Slocum B, Devine T. Cranial tibial wedge osteotomy – a technique for eliminating cranial tibial thrust in cranial cruciate ligament repair. J Am Vet Med Assoc 1984; 184: 564-549.
  • 6 Montavon PM, Damur DM, Tepic S. Advancement of the tibial tuberosity for the treatment of cranial cruciate deficient canine stifle. Proceedings of the 1st World Orthopaedic Veterinary Congress. 2002. September 5-8; Munich Germany; 152.
  • 7 Kunkel KAR, Basinger RR, Suber JT. et al. Evaluation of a transcondylar toggle system for stabilization of the cranial cruciate deficient stifle in small dogs and cats. Vet Surg 2009; 38: 975-982.
  • 8 Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993; 23: 777-795.
  • 9 Lafaver S, Miller NA, Stubbs WP. et al. Tibial tuberosity advancement for stabilization of the canine cranial cruciate ligament-deficient stifle joint: Surgical technique, early results, and complications in 101 dogs. Vet Surg 2007; 36: 573-586.
  • 10 Beal MW, Brown DC, Shofer FS. The effects of perioperative hypothermia and the duration of anesthesia on postoperative wound infection rate in clean wounds: A retrospective study. Vet Surg 2000; 29: 123-127.
  • 11 Brown DC, Conzemius MG, Shofer F. et al. Epidemiologic evaluation of postoperative wound infections in dogs and cats. J Am Vet Med Assoc 1997; 210: 1302-1306.
  • 12 Vasseur PB, Levy J, Dowd E. et al. Surgical wound infection rates in dogs and cats. Data from a teaching hospital. Vet Surg 1988; 17: 60-64.
  • 13 Whittem TL, Johnson AL, Smith CW. et al. Effect of perioperative prophylactic antimicrobial treatment in dogs undergoing elective orthopedic surgery. J Am Vet Med Assoc 1999; 215: 212-216.
  • 14 Wolf RE, Scavelli TD, Hoelzler MG. et al. Surgical and postoperative complications associated with tibial tuberosity advancement for cranial cruciate ligament rupture in dogs: 458 cases (2007-2009). J Am Vet Med Assoc 2012; 240: 1481-1487.
  • 15 Proot JL, Corr SA. Clinical audit for the tibial tuberosity advancement procedure: establishing the learning curve and monitoring ongoing performance for the tibial tuberosity advancement procedure using the cumulative summation technique. Vet Comp Orthop Traumatol 2013; 26: 280-284.
  • 16 Frey TN, Hoelzler MG, Scavelli TD. et al. Risk factors for surgical site infection-inflammation in dogs undergoing surgery for rupture of the cranial cruciate ligament: 902 cases (2005-2006). J Am Vet Med Assoc 2010; 236: 88-94.
  • 17 Fitzpatrick N, Solano MA. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 2010; 39: 460-474.
  • 18 Solano MA, Danielski A, Kovach K. et al. Locking plate and screw fixation after tibial plateau leveling osteotomy Reduces postoperative infection rate in dogs over 50 kg. Vet Surg 2014; 44: 59-64.
  • 19 Nazarali A, Singh A, Weese JS. Perioperative administration of antimicrobials during tibial plateau leveling osteotomy. Vet Surg 2014; 43: 966-971.
  • 20 Horan TC, Gaynes RP, Martone WJ. et al. CDC definitions of nosocomial surgical site infections, 1992 – a modification of CDC definitions of surgical wound infections. Am J Infect Control 1992; 20: 271-274.
  • 21 Nutt A, Parkin T, Calvo I. Risk factors for tibial tuberosity fracture after tibial tuberosity advancement in dogs. Proceedings of the 4th World Veterinary Orthopaedic congress & the 41st Veterinary Orthopaedic Society Conference. Vet Comp Orthop Tramatol. 2014: A13.
  • 22 Gallagher AD, Mertens WD. Implant removal rate from infection after tibial plateau leveling osteotomy in dogs. Vet Surg 2012; 41: 705-711.
  • 23 Savicky R, Beale B, Murtaugh R. et al. Outcome following removal of TPLO implants with surgical site infection. Vet Comp Orthop Tramatol 2013; 26: 260-265.
  • 24 Soontornvipart K, Necas A, Dvorak M. Effects of metallic implant on the risk of bacterial osteomyelitis in small animals. Acta Vet Brno 2003; 72: 235-247.
  • 25 Pacchiana PD, Morris E, Gillings SL. et al. Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998-2001). J Am Vet Med Assoc 2003; 222: 184-193.
  • 26 Kuan S, Smith B, Black A. Tibial wedge ostectomy: complications of 300 surgical procedures. Aust Vet J 2009; 87: 438-444.
  • 27 von Pfeil DJF, Edwards MR, Nelson NC. Handling of the tibial muscle envelope in tibial plateau levelling, osteotomy – to elevate or not? A clinical study of 40 dogs. Vet Comp Orthop Tramatol 2013; 26: 392-398.
  • 28 Nelson LL. Surgical site infections in small animal surgery. Vet Clin North Am Small Anim Pract 2011; 41: 1041-1056.
  • 29 Boudrieau RJ. Tibial plateau leveling osteotomy or tibial tuberosity advancement?. Vet Surg 2009; 38: 1-22.
  • 30 Arens S, Hansis M, Schlegel U. et al. Infection after open reduction and internal fixation with dynamic compression plates--clinical and experimental data. Injury 1996; 27 (Suppl. 03) SC27-33.
  • 31 Arens S, Schlegel U, Printzen G. et al. Influence of materials for fixation implants on local infection. An experimental study of steel versus titanium DCP in rabbits. J Bone Joint Surg Br 1996; 78: 647-651.
  • 32 Moriarty TF, Debefve L, Boure L. et al. Influence of material and microtopography on the development of local infection in vivo: experimental investigation in rabbits. Int J Artif Organs 2009; 32: 663-670.
  • 33 Schlegel U, Perren SM. Surgical aspects of infection involving osteosynthesis implants: implant design and resistance to local infection. Injury 2006; 37 (Suppl. 02) S67-73.
  • 34 Tenover FC. Mechanisms of antimicrobial resistance in bacteria. Am J Med 2006; 119: S3-S10.
  • 35 Meijer WS, Schmitz PI, Jeekel J. Meta-analysis of randomized, controlled clinical trials of antibiotic prophylaxis in biliary tract surgery. Brit J Surg 1990; 77: 283-290.
  • 36 Kreter B, Woods M. Antibiotic prophylaxis for cardiothoracic operations. Meta-analysis of thirty years of clinical trials. J Thorac Cardiov Sur 1992; 104: 590-599.
  • 37 Wymenga AB, Hekster YA, Theeuwes A. et al. Antibiotic use after cefuroxime prophylaxis in hip and knee joint replacement. Clinical Pharmacol Ther 1991; 50: 215-220.
  • 38 Hecker MT, Aron DC, Patel NP. et al. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med 2003; 163: 972-978.
  • 39 Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Am J Surg 2005; 189: 395-404.
  • 40 Steinberg JP, Braun BI, Hellinger WC. et al. Timing of antimicrobial prophylaxis and the risk of surgical site infections results from the trial to reduce antimicrobial prophylaxis errors. Ann Surg 2009; 250: 10-16.
  • 41 Koch CG, Li L, Hixson E. et al. Is it time to refine? An exploration and simulation of optimal antibiotic timing in general surgery. J Am Coll Surg 217: 628-635.
  • 42 Weber WP, Marti WR, Zwahlen M. et al. The timing of surgical antimicrobial prophylaxis. Ann Surg 2008; 247: 918-926.
  • 43 Weese JS, Hailing KB. Perioperative administration of antimicrobials associated with elective surgery for cranial cruciate ligament rupture in dogs: 83 cases (2003-2005). J Am Vet Med Assoc 2006; 229: 92-95.
  • 44 Ribeiro M, Monteiro FJ, Ferraz MP. Infection of orthopedic implants with emphasis on bacterial adhesion process and techniques used in studying bacterial-material interactions. Biomatter 2012; 02: 176-194.
  • 45 Brady RA, Leid JG, Costerton JW. et al. Osteomyelitis: Clinical overview and mechanisms of infection persistence. Clin Microbiol Newsl 2006; 28: 65-72.
  • 46 Eugster S, Schawalder P, Gaschen F. et al. A prospective study of postoperative surgical site infections in dogs and cats. Vet Surg 2004; 33: 542-550.
  • 47 Cruse PJ, Foord R. The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin N Am 1980; 60: 27-40.
  • 48 Haley RW, Culver DH, Morgan WM. et al. Identifying patients at high-risk of surgical wound-infection – a simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 1985; 121: 206-215.
  • 49 Wong ES. Surgical site infections. In: Maryhall DG. Editor. Hospital Epidemiology and Infection Control. 2nd ed. Philadelphia: Lippincott, Williams & Wilkins; 1996: 189-210.
  • 50 Kurz A, Sessler DI, Lenhardt R. Perioperative nor-mothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of wound infection and temperature group. New Engl J Med 1996; 334: 1209-1215.
  • 51 Weese JS, van Duijkeren E. Methicillin-resistant Staphylococcus aureus and Staphylococcus pseud-intermedius in veterinary medicine. Vet Microbiol 2010; 140: 418-429.
  • 52 Turk R, Singh A, Weese JS. Prospective surgical site infection surveillance in dogs. Vet Surg 2015; 44: 2-8.
  • 53 Magiorakos AP, Srinivasan A, Carey RB. et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infec 2012; 18: 268-281.