Table 3.
Prospective and Retrospective Studies Assessing the Association between Operative Duration and Surgical Site Infection with a Reported Odds Ratio (and Estimated Relative Risk if Data Available)
| Reference | Sample size | SSI overall | OR time cutoff point | Surgery type | Odds ratio | 95% CI | p | |
|---|---|---|---|---|---|---|---|---|
| General surgery | ||||||||
| Utsumi et al. (2010) | 12,051* | 1.4% | NR | Lap. Chole. | 4.17 | 1.97–8.80 | <0.001 | |
| 8% | Open Chole. | 2.14 | 1.13–4.05 | 0.019 | ||||
| 10.2% | Gastrectomy | 2.33 | 1.82–2.98 | <0.001 | ||||
| 12.4% | Appy | 1.93 | 1.30–2.87 | 0.001 | ||||
| 17.3% | Colon resec. | 1.33 | 1.05–1.67 | 0.016 | ||||
| 24.2% | Rectal resec. | 1.34 | 1.00–1.80 | 0.048 | ||||
| Biscione et al. (2007) | 6,892* | 3.2% | ≥ 2 h vs. <2 h | DEAC | — | — | — | |
| Elola-Olaso et al. (2012) | 2,332* | 11.5% | Per min | Hepatectomy | 1.003 | 1.001–1.004 | <0.001 | |
| Han et al. (2014) | 1,330 | 4.5% | ≥ 3 h vs. <3 h | Gastrectomy | 2.46 | 1.42–4.26 | 0.001 | |
| Lee et al. (2011) | 655 | 12.5% | Per hour† | Midline Lap. | 1.20 | 1.06–1.36 | 0.003 | |
| Anaya et al. (2012) | 503 | 24% | ≥ 2 h vs. <2 h | Oncology | 1.75 | 1.01–3.04 | 0.04 | |
| ≥ 4 h vs. <4 h | 2.24 | 1.22–4.10 | 0.009 | |||||
| Stremitzer et al. (2010) | 478 | 6.5% | Per 15 min† | Hernia | 1.13 | 1.04–1.23 | 0.0038 | |
| Uchino et al. (2013) | 405 | 27% | ≥ 2.8 h vs. <2.8 h | Abdominal | 3.95 | 2.20–7.09 | <0.01 | |
| Smith et al. (2012) | 306* | 24.7% | Per 1 min† | Trauma Lap. | 1.00 | 1.002–1.007 | <0.001 | |
| Nanashima et al. (2014) | 186 | 29%–35% | ≥ 8.5 h vs. <8.5 h | Hepatic resec. | 1.41 | 0.61–3.24 | 0.413 | |
| Short et al. (2011) | 181 | 15% | NR | Abdominal | 1.00 | 1.00–1.01 | 0.30 | |
| Freire et al. (2013) | 543 | 24% | NR | Liver Tx. | 1.57 | 0.98–2.52 | 0.06 | |
| Hellinger et al. (2009) | 370 | 18% | NR | Liver Tx. | — | — | — | |
| Sadamori et al. (2013) | 359 | 14.5% | ≥ 4.7 h vs. <4.7 h | Hepatectomy | 2.32 | 1.22–4.43 | 0.011 | |
| Showalter et al. (2013) | 150 | 30% | ≥ 4.5 h vs. <4.5 h | Abdominal resec. | 1.27b | — | 0.50 | |
| Lopez-Ben et al. (2014) | 147 | 12% | 3.8 h vs. ≤3.8 h | Hepatectomy | 0.86c | 0.31–2.28 | 0.77 | |
| Nguyen et al. (2012) | 48,393*- | 3.5% | ≥ 3 to <6 h vs. <3 h | Mastectomy | 1.27 | 0.98–1.64 | 0.071 | |
| ≥ 6 h vs. <3 h | 1.67 | 1.11–2.50 | 0.013 | |||||
| Davis et al. (2013) | 38,739* | 2.3% | ≥ 2 h vs. <2 h | Mastectomy | 1.60 | 1.39–1.84 | <0.0001 | |
| Winocour et al. (2015) | 12,426* | 2%–3.4% | > 4.2 h vs. ≤4.2 h | Mastectomy, ITEBR | 1.90 | 1.50–2.40 | <0.001 | |
| Nakahira et al. (2013) | 1,926* | 12.8% | >5 h vs. ≤5 h | BILI-H | 2.90 | 1.90–4.40 | <0.001 | |
| 33.5% | BILI-nonH | 1.90 | 1.40–2.60 | <0.001 | ||||
| Colon and Rectal Surgery | ||||||||
| Kohut et al. (2015) | 89,098* | 13.3% | > 3 h vs. ≤3 h | Multiple | 1.53 | 1.44–1.62 | 0.001 | |
| Aimaq et al. (2011) | 23,939* | 9%–16% | NR | Colon | 1.003 | NR | <0.001 | |
| Kiran et al. (2010) | 10,979* | 14% | ≥ 3 h vs. <3 h | Multiple | 1.41 | 1.22–1.62 | <0.001 | |
| Alavi et al. (2010) | 3,981* | 22.6% | 1.8–2.6 h | Ref: 0.6–1.7 h | Bowel resec. | 1.52 | 1.21–1.91 | NR |
| 2.6–3.8 h | 1.84 | 1.46–2.31 | ||||||
| > 3.8 h | 2.61 | 2.06–3.30 | ||||||
| Kurmann et al. (2011) | 2,571* | 3.5% | > 4h vs. ≤4 h | Sigmoid resec. | 1.70 | 1.00–2.80 | 0.03 | |
| Hubner et al. (2011) | 2,393* | 17.9% | > 3 h vs. ≤3 h | Colon surgery | 1.51 | 1.22–1.93 | <0.001 | |
| Fukuda et al. (2013) | 1,530* | 12.1% | Per 10 min† | Multiple | 1.05 | 1.03–1.07 | <0.001 | |
| Drosdeck (2013) | 419 | 10.3% | NR | Lap. colon resec. | 1.00c | 1.00–1.01 | 0.07 | |
| Miki et al. (2006) | 285 | 21% | NR | Colorectal resec. | 1.01d | 1.002–1.018d | 0.011d | |
| Howard et al. (2010) | 122 | 7%–25% | > 4 h vs. ≤4 h | LCS or OCS | 2.50a | NR | 0.046 | |
| Sergeant et al. (2008) | 101 | 20.7% | NR | Colorectal resec. | 1.02 | 1.01–1.04 | 0.014 | |
| Obstetrics and Gynecology | ||||||||
| Mahdi et al. (2014) | 28,366* | 4% | ➢3 h vs. ≤3 h | Ab. hysterectomy | 1.80 | 1.20–2.60 | 0.002 | |
| 2% | Lap. hysterectomy | 2.20 | 1.01–4.90 | 0.049 | ||||
| Lake (2013) | 13,822* | 1.1% | > 75th percentile | Hysterectomy | — | — | — | |
| Chunder et al. (2012) | 1,100 | 7% | Per 1 min† | Cesarean delivery | 1.09 | 1.05–1.15 | <0.0001 | |
| Opoien et al. (2007) | 326 | 8.9% | ≥ 0.6 h vs. <0.6 h | Cesarean delivery | 2.40 | 1.10–5.30 | 0.026 | |
| Williams et al. (2013) | 160 | 13.8% | NR | Cesarean delivery | 1.04 | 1.002–1.075 | 0.037 | |
| Tran et al. (2015) | 888 | 10.8% | NR | Primary surgery for EOC | 1.18 | 1.03–1.36 | <0.05 | |
| Neurologic | ||||||||
| Korinek et al. (2005) | 4,578 | 6.6% | ≥ 4 h vs. <4 h | Craniotomy | 1.16 | 1.09–1.24 | NR | |
| Valentini et al. (2008) | 1,747 | 0.7% | 2 h vs. ≤1 h | Craniotomy, spinal | — | — | — | |
| 3–4 h vs. ≤1 h | — | — | ||||||
| 2 h vs. ≤1 h | Craniotomy only | — | — | |||||
| 3–4 h vs. ≤1 h | — | — | ||||||
| Zhan et al. (2014) | 1,470 | 7.4% | NR | Mainly craniotomies | 1.33 | 1.23–1.44 | <0.001 | |
| Theophilus and Adnan (2011) | 90 | 14.4% | > 1 h vs. <1 h | VPS insertion | 5.65b | 1.12–27.2 | NR | |
| Orthopedic | ||||||||
| Namba et al. (2013) | 56,216* | 0.72% | NR | TKA | 1.11e | 1.07–1.15 | <0.001 | |
| Ridgeway et al. (2005) | 24,808* | 3.1% | 1.5–2 h | Ref: 1–1.5 h | Hip replacement | 1.23 | 0.96–1.57 | |
| ≥ 2 h | 1.58 | 1.23–2.03 | ||||||
| Naranje et al. (2015) | 9,973* | - | 15 min† | TKA | 15.6%f | 0%–34.1% | 0.053 | |
| Kremers (2015) | 8,270 | 1.3% | Per 10 min† | THA | 1.01e | 0.98–1.02 | NR | |
| 1.9% | TKA | 1.00e | 0.98–1.02 | |||||
| Skramm et al. (2012) | 4,177 | 3%–7% | NR | Multiple | NR | NR | <0.001 | |
| Maoz et al. (2015) | 4,078 | 1.3% | > 1.9 h vs. ≤1.9 h | THA | 3.38 | 1.23–9.28 | 0.018 | |
| Li et al. (2013) | 2,061 | 2.18% | > 3 h vs. ≤3 h | Multiple | 3.63 | 1.89–6.97 | <0.001 | |
| Nagano et al. (2014) | 457 | 12.2% | ≥ 5.9 h vs. <5.9 h | Musculoskeletal | 6.06c | 2.1–17.4 | 0.0003 | |
| Suzuki et al. (2010) | 326 | 5.2% | Per min† | Fracture fixation | 1.00 | 0.90–1.10 | 0.387 | |
| Colman et al. (2013) | 309 | 7.8% | Per 1 h† | Plate osteosynthesis | 1.78 | 1.12–2.80 | 0.01 | |
| Lin (2014) | 251 | 7.8% | NR | Tibial ORIF | 2.70 | 1.60–4.40 | <0.001 | |
| Kourbatova et al. (2005) | 95 | 9.5% | > 3 h vs. ≤3 h | TKA or THA | 7.40 | 1.40–39.6 | NR | |
| Otolaryngology | ||||||||
| Elfenbein et al. (2014) | 49,326* | 0.36% | Per min† | Cervical thyroidectomy | 1.004 | 1.002–1.006 | <0.001 | |
| Bures et al. (2014) | 6,778 | 0.49% | Per 30 min† | Multiple | 1.17 | 1.05–1.30 | 0.004 | |
| Sato et al. (2011) | 66 | 21% | NR | Tracheostomy, RND | 0.52 | 0.05–5.61 | 0.59 | |
| Ma et al. (2012) | 376 | 23% | ≥ 6 h vs. <6 h | Cervical thyroidectomy | 7.33 | 4.59–9.16 | 0.0003 | |
| Multiple Surgical Specialties | ||||||||
| Astagneau et al. (2009) | 964,128* | 1.54% | > 75th percentile | Multiple | — | — | — | |
| Herruzo et al. (2013) | 26,810 | 4.8% | 1–3 h vs. <1 h | Multiple | 2.30 | 1.70–3.04 | NR | |
| >3 h vs. <1 h | 5.10 | 3.63–7.12 | ||||||
| Khoshbin et al. (2014) | 5,309 | 2.3% | NR | Multiple | — | — | — | |
| Ogihara et al. (2015) | 2,736 | 0.9% | ≥ 3 h vs. <3 h | Thoracic or lumbar spine | 10.28g | 3.31–39.36 | <0.0001 | |
| Boltz et al. (2011) | 2,250 | 8.3% | 4–8 h vs. | Multiple | 1.79 | 1.25–2.58 | 0.002 | |
| > 8 h vs. | 3.23 | 2.06–5.04 | <0.0001 | |||||
| Wick (2009) | 1,646 | 9.4% | ≥ 3 h vs. <3 h | Multiple | 1.73 | 1.04–2.87 | 0.034 | |
| Ata et al. (2010) | 1,561 | 4.36% | Per 10 min† | General | 1.05 | 1.04–1.07 | <0.001 | |
| 10.3% | Vascular | 1.06 | 1.04–1.08 | NR | ||||
| Pathak et al. (2014) | 720 | 5% | ≥ 1 h vs. <1 h | Multiple | 2.55 | 1.20–5.44 | 0.015 | |
| Harbarth et al. (2008) | 670 | 1.1% | > 75th percentile | Multiple | 3.00 | 1.70–5.10 | NR | |
| Haridas et al. (2008) | 600 | 3.1% | ≥ 75th percentile | Multiple | 1.80 | 1.20–2.80 | NR | |
Risk ratio (95% CI) reported in publication; unadjusted analysis.
Calculated odds ratio and/or relative risk based on data in the paper (unadjusted analyses).
Odds ratio (95% CI) reported in the publication; unadjusted analysis.
Results in table reported for organ/space SSI. Incisional SSI odds ratio [95%CI]; p = 0.99 [0.983–0.997]; 0.0068.
Hazard ratio (95% CI) reported; unadjusted analysis.
The hazard of revision resulting from infection with a 15-min increase in operative time; multivariate Cox proportional hazards model.
Effect measure (odds ratio or risk ratio) reported for deep SSI versus non-deep SSI.
—indicates data not available or RR could not be estimated with data available.
indicates that the study is a multi-centre study
indicates increase
Results reflect adjustment for multiple variables unless otherwise specified.
Bold text indicates statistical significance
Ab = abdominal; Appy = appendectomy; BILI = hepato-biliary-pancreatic surgery; BILI-H = BILI hepatectomy; BILI-nonH = BILI hepato-biliary pancreatic surgery except for hepatectomy; Chole = cholecystectomy; CI = confidence interval; DEAC = diagnostic exploration of the abdominal cavity; EOC = epithelial ovarian cancer; HA = hemiarthroplasty; ID = inpatient discharge; ITEBR = immediate tissue expander breast reconstruction; Lap = laparotomy; Lap chole = laparoscopic cholecystectomy; Lap colon resec = laparoscopic colon resection; LCS = laparoscopic colorectal surgery; MA = meta-analysis; MD = median duration; min = minutes; MRSA = methicillin-resistant Staphylococcus aureus; NR = not reported; NS = not significant; OCS = open colorectal surgery; OR = operative room time; ORIF = open reduction and internal fixation; PHA = primary hip arthroplasty; PJI = periprosthetic joint infection; RCT = randomized controlled trial; Ref = reference category; Resec = resection; RND = radical neck dissection; SILC = single-incision laparoscopic cholecystectomy; SR = systematic review; SSI = surgical site infection; THR = total hip replacement; THA = total hip arthroplasty; TKA = total knee arthroplasty; Tx = transplant; VPS = ventriculoperitoneal shunt; WI = wound infection.