{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:24:30Z","timestamp":1791829470550,"version":"4.3.4"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,7,19]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Infection after tumor resection and endoprosthetic reconstruction is a potentially limb-threatening complication. The duration of surgery has been shown to be a risk factor for infection, but the ability of an extended duration of postoperative prophylactic antibiotics to potentially minimize that risk has not been specifically studied. The objective of this study was to determine whether extended postoperative antibiotic therapy protects against surgical site infection (SSI) in the setting of prolonged surgical duration in patients undergoing endoprosthetic reconstruction after tumor resection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This study was a planned secondary analysis of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial data set. Patients in the PARITY trial were randomized to receive 24 hours or 5 days of postoperative prophylactic antibiotics. The current study assessed the risk of SSI in those cohorts on the basis of surgical duration. A multivariable regression model was used to examine the adjusted effects of the duration of surgery on SSI, after controlling for other significant risk factors and potential confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>All 604 patients who had been included in the final data analysis in the PARITY trial were also included in this secondary analysis. Those who sustained an SSI had a greater mean duration of surgery (6.2 hours) compared with those who did not sustain an SSI (4.9 hours, p &lt; 0.0001). There was no specific time point at which the risk of infection significantly increased. Extended postoperative prophylactic antibiotic therapy did not appear to mitigate the risk of SSI even in patients with prolonged surgical duration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Increased surgical duration was an independent risk factor for SSI in orthopaedic patients undergoing endoprosthetic reconstruction after tumor resection. However, surgical duration is multifactorial and is influenced by several variables. For example, there may be protective features of flap coverage that increase surgical duration while paradoxically decreasing the risk of SSI. Extended postoperative antibiotic therapy did not mitigate the risk of infection in this cohort, and other risk mitigation strategies will need to be considered in future studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.23.00056","type":"journal-article","created":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T11:04:13Z","timestamp":1689764653000},"page":"79-86","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":13,"title":["Surgical Duration Is Independently Associated with an Increased Risk of Surgical Site Infection and May Not Be Mitigated by Prolonged Antibiotics"],"prefix":"10.2106","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2496-1829","authenticated-orcid":false,"given":"Lauren","family":"Zeitlinger","sequence":"first","affiliation":[{"name":"University of Pittsburgh Medical Center, Harrisburg, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1734-2755","authenticated-orcid":false,"given":"Machelle","family":"Wilson","sequence":"additional","affiliation":[{"name":"University of California, Davis, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3660-774X","authenticated-orcid":false,"given":"R. Lor","family":"Randall","sequence":"additional","affiliation":[{"name":"University of California, Davis, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3127-4912","authenticated-orcid":false,"given":"Steven","family":"Thorpe","sequence":"additional","affiliation":[{"name":"University of California, Davis, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the PARITY Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,7,19]]},"reference":[{"issue":"9","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.2106\/00004623-198668090-00005","article-title":"Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur","volume":"68","author":"Simon","year":"1986","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1001\/jamaoncol.2021.6628","article-title":"Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) Investigators. Comparison of Prophylactic Intravenous Antibiotic Regimens After Endoprosthetic Reconstruction for Lower Extremity Bone Tumors: A Randomized Clinical Trial","volume":"8","author":"Ghert","year":"2022","journal-title":"JAMA Oncol."},{"issue":"6","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"2017","DOI":"10.1007\/s11999-013-2842-9","article-title":"High infection rate outcomes in long-bone tumor surgery with endoprosthetic reconstruction in adults: a systematic review","volume":"471","author":"Racano","year":"2013","journal-title":"Clin Orthop Relat Res."},{"issue":"3","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1089\/sur.2014.049","article-title":"Deep Infections after Endoprosthetic Replacement Operations in Orthopedic Oncology Patients","volume":"16","author":"Dhanoa","year":"2015","journal-title":"Surg Infect (Larchmt)."},{"issue":"7","key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1245\/ASO.2003.07.023","article-title":"Prospective identification of risk factors for wound infection after lower extremity oncologic surgery","volume":"10","author":"Morris","year":"2003","journal-title":"Ann Surg Oncol."},{"issue":"3","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"223","DOI":"10.2106\/JBJS.L.01514","article-title":"Surgical site infection in orthopaedic oncology","volume":"96","author":"Gradl","year":"2014","journal-title":"J Bone Joint Surg Am."},{"issue":"2Suppl","key":"bib7-20250430","first-page":"271","article-title":"Infection in orthopaedic oncology: crucial problem in modern reconstructive techniques","volume":"23","author":"Trovarelli","year":"2019","journal-title":"Eur Rev Med Pharmacol Sci."},{"issue":"Suppl 2","key":"bib8-20250430","doi-asserted-by":"crossref","first-page":"36","DOI":"10.2106\/JBJS.J.01046","article-title":"Preventing infection in total joint arthroplasty","volume":"92","author":"Matar","year":"2010","journal-title":"J Bone Joint Surg Am."},{"issue":"7","key":"bib9-20250430","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1007\/s11999-008-0209-4","article-title":"Periprosthetic joint infection: the incidence, timing, and predisposing factors","volume":"466","author":"Pulido","year":"2008","journal-title":"Clin Orthop Relat Res."},{"issue":"8","key":"bib10-20250430","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1016\/j.arth.2009.08.011","article-title":"Incidence and risk factors for deep surgical site infection after primary total hip arthroplasty: a systematic review","volume":"25","author":"Urquhart","year":"2010","journal-title":"J Arthroplasty."},{"issue":"2","key":"bib11-20250430","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.jhin.2011.06.001","article-title":"Risk factors for prosthetic hip and knee infections according to arthroplasty site","volume":"79","author":"Peel","year":"2011","journal-title":"J Hosp Infect."},{"issue":"8","key":"bib12-20250430","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1302\/0301-620X.92B8.24333","article-title":"Factors affecting the incidence of infection in hip and knee replacement: an analysis of 5277 cases","volume":"92","author":"Willis-Owen","year":"2010","journal-title":"J Bone Joint Surg Br."},{"key":"bib13-20250430","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/00003086-200111000-00003","article-title":"Infection in total knee replacement: a retrospective review of 6489 total knee replacements","volume":"392","author":"Peersman","year":"2001","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib14-20250430","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1007\/s11999-009-1013-5","article-title":"Prosthetic joint infection risk after TKA in the Medicare population","volume":"468","author":"Kurtz","year":"2010","journal-title":"Clin Orthop Relat Res."},{"issue":"7","key":"bib15-20250430","doi-asserted-by":"crossref","first-page":"2256","DOI":"10.1016\/j.arth.2018.02.037","article-title":"Impact of Operative Time on Adverse Events Following Primary Total Joint Arthroplasty","volume":"33","author":"Bohl","year":"2018","journal-title":"J Arthroplasty."},{"issue":"20","key":"bib16-20250430","doi-asserted-by":"crossref","first-page":"e923","DOI":"10.5435\/JAAOS-D-19-00582","article-title":"Risk Factors for Surgical Site Infection in Orthopaedic Oncology","volume":"28","author":"Anatone","year":"2020","journal-title":"J Am Acad Orthop Surg."},{"issue":"12","key":"bib17-20250430","doi-asserted-by":"crossref","first-page":"7312","DOI":"10.1245\/s10434-022-12258-w","article-title":"Neoadjuvant Chemotherapy and Endoprosthetic Reconstruction for Lower Extremity Sarcomas: Does Timing Impact Complication Rates?","volume":"29","author":"Gazendam","year":"2022","journal-title":"Ann Surg Oncol."},{"issue":"8425","key":"bib18-20250430","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/S0140-6736(85)91399-6","article-title":"Prevention of airborne infection during surgery","volume":"1","author":"Howorth","year":"1985","journal-title":"Lancet."},{"issue":"7S","key":"bib19-20250430","doi-asserted-by":"crossref","first-page":"S331","DOI":"10.1016\/j.arth.2018.11.022","article-title":"Is Operative Time a Predictor for Post-Operative Infection in Primary Total Knee Arthroplasty?","volume":"34","author":"Anis","year":"2019","journal-title":"J Arthroplasty."},{"issue":"3","key":"bib20-20250430","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/S0196-6553(98)80004-7","article-title":"Risk index for prediction of surgical site infection after oncology operations","volume":"26","author":"Velasco","year":"1998","journal-title":"Am J Infect Control."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.23.00056","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:44:28Z","timestamp":1787751868000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.23.00056"}},"subtitle":["A Secondary Analysis of the PARITY Trial of Infection After Lower-Extremity Endoprosthetic Reconstruction for Bone Tumors"],"short-title":[],"issued":{"date-parts":[[2023,7,19]]},"references-count":20,"journal-issue":{"issue":"Suppl 1","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.23.00056","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,19]]}}}