Is there a correlation between operative time and the risk of subsequent surgical site infection/periprosthetic joint infection (SSI/PJI) in patients undergoing tumor resection and endoprosthetic reconstruction? If so, should postoperative antibiotics be prolonged in these patients?

Authors: Christina Gutowski, Michelle Ghert, Qiaojie Wang

RECOMMENDATION: Based largely on the arthroplasty literature, there is considerable evidence that prolonged operative time is associated with an increased risk for postoperative infection. However, there is insufficient evidence to suggest that a prolonged postoperative antibiotic regimen can mitigate this risk. Therefore, there is no evidence to support prolonged postoperative antibiotics in orthopaedic oncology patients undergoing surgeries of prolonged duration. If the duration of the procedure exceeds two half-lives of the prophylactic antimicrobial, intraoperative redosing is needed to ensure adequate serum and tissue concentrations of the antimicrobial.

LEVEL OF EVIDENCE: Moderate

DELEGATE VOTE: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

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