A new retrospective cohort study of 11,163 patients who’d been treated with orthopedic surgery between January 2018 and January 2020 has looked at the relationship between operating room (OR) size and surgical site infection (SSI) rates. Their work, “The Effect of Operating Room Size on Orthopaedic Surgical Site Infection Rates,” was published in the December 1, 2021 edition of The Journal of the American Academy of Orthopaedic Surgeons.
Does the Size of the OR Increase Infection Rates?
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“We decided to do this study mainly based upon the variability of operating room sizes seen within our health system. As many of the operating rooms are different sizes, based upon building codes at the time when the hospitals were constructed, we sought to identify if any association existed between the size of the operating room and orthopedic surgical site infection rates,” stated co-author Tyler Tantillo, D.O. to OTW. Dr. Tantillo is with the Department of Orthopedic Surgery at the Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Plainview Hospital in Plainview, New York.
The researchers noted the total net square footage of all ORs and determined the incidence of SSIs. They defined a small OR as 250 to 399 net square feet, a medium OR as 400 to 549 net square feet, and a large OR as 550 to 699 net square feet.
The team found that 137 patients (1.2%) developed an SSI. Of these, 16 (11.7%) were found in small ORs, 83 (60.6%) in medium ORs, and 38 (27.7%) in large ORs. The incidence of SSIs was 0.7% in small ORs, 1.3% in medium ORs, and 1.8% in large ORs. The authors wrote, “Factors found to significantly impact SSIs included medium-sized ORs, younger patients, procedure type (fusions and emergencies/traumas), longer procedures, and higher American Society of Anesthesiologists scores.”
Dr. Tantillo told OTW, “Our results showed, that after accounting for known independent risk factors for orthopaedic surgical site infections, medium-sized operating rooms (400 to 549 net square feet) had higher rates of infection as compared to smaller (250 to 399 net square feet) and larger (550 to 699 net square feet) operating rooms.”
“The clinical implications of our study are to guide future prospective studies in isolating operating room size as a key risk factor in the development of a surgical site infection and, to ultimately aid in the construction of future operating rooms to improve efficiency and workflow as well as surgical site infection reduction.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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