Examining the Efficacy of Drain Tip Cultures in Predicting Postoperative Surgical Site Infections in Hip Arthroplasty: A 15-Year Retrospective Study

Akira Toga; Ayush Balaji; Osamu Hemmi; Ken Ishii; Shigeyuki Tokunaga; Shojiro Katoh; Ryoichi Izumida

doi:10.7759/cureus.46395

Examining the Efficacy of Drain Tip Cultures in Predicting Postoperative Surgical Site Infections in Hip Arthroplasty: A 15-Year Retrospective Study

Cureus. 2023 Oct 3;15(10):e46395. doi: 10.7759/cureus.46395. eCollection 2023 Oct.

Authors

Akira Toga^{1

2}, Ayush Balaji^{1

3}, Osamu Hemmi⁴, Ken Ishii^{2

4

5}, Shigeyuki Tokunaga⁶, Shojiro Katoh¹, Ryoichi Izumida⁴

Affiliations

¹ Department of Orthopaedic Surgery, Edogawa Hospital, Tokyo, JPN.
² Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, JPN.
³ Medicine, Hull York Medical School, York, GBR.
⁴ Keiyu Artificial Joint Center, Edogawa Hospital, Tokyo, JPN.
⁵ Spine Surgery, Society for Minimally Invasive Spinal Treatment (MIST), Tokyo, JPN.
⁶ Department of Orthopedic Surgery, Edogawa Hospital, Tokyo, JPN.

Abstract

Background Postoperative surgical site infections (SSIs) are a significant complication of surgical procedures, leading to increased morbidity, prolonged hospital stays, and substantial healthcare costs; however, the use of drain tip cultures to diagnose SSIs in patients is controversial. The objective of this study was to evaluate the efficacy of drain tip cultures for the prediction of postoperative SSIs in patients recovering from hip arthroplasty. Methodology The data were collected from 1204 patients who underwent hip arthroplasty procedures over 15 years, and statistical analysis was performed to evaluate the diagnostic value of drain tip culture in determining surgical site infection. We also used these data to evaluate whether preexisting conditions such as hypertension or diabetes affected the probability of a patient getting an SSI. Results Drain tip cultures were positive in 12 of 1,112 cases of primary hip arthroplasty, but only one of these 12 patients was ultimately diagnosed with an SSI (sensitivity, 12.5%; specificity, 99.0%; p = 0.0834). Results from postoperative drain tip cultures performed in patients undergoing revision arthroplasty included two false positives and three false negatives; interestingly, no true positives were detected in any of the revision arthroplasty cases we evaluated (sensitivity, 0％; specificity, 97.8％; p = 0.9355). Conclusion Our results indicate that drain tip cultures have no statistically significant predictive value for the diagnosis of postoperative SSIs and thus should not be used as a primary diagnostic or predictive tool for SSIs. We recommend exploring other diagnostic tools for the postoperative diagnosis of SSIs. Standardized guidelines should therefore be established to improve the predictive value of the different methods.

Keywords: bipolar hip arthroplasty (bha); drain tip culture; postsurgical infection; primary hip replacement; prognostic value; revision hip arthroplasty; surgical drain; surgical site infection; total hip arthroplasty (tha).