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NIck Gill - Cwm Taf Local Health Board - South Wales, UKMichael Lewis - Cwm Taf Local Health Board - South Wales, UK*Peter Lewis - Cwm Taf Local Health Board - South Wales, UK*Email: pete_lewis5@hotmail.comIntroductionInfection is a catastrophic event following any joint replacement surgery. A number oftechniques have been adopted to reduce the risk of perioperative infection, one of which beingthe use of ultra clean air laminar flow theatres. Although their use would appear to be avaluable adjunct against infection and “recommended” by national orthopaedic associations,there is little high quality evidence available confirming infection reduction. There is evenrecent evidence reporting a paradoxical effect, with use causing an associated increasedinfection rate. In the UK, high-level comparative evidence assessing the effectiveness of thesetheatres will be difficult to obtain for joint replacement surgery with clinical reluctance andprobable ethical impossibility to perform such cases in a standard theatre. This is however notthe case for the allied specialty of vascular surgery. Although also using prosthetic implantsthere is no such recommendation for the use of clean air theatres and therefore provides anopportunity to perform investigation into their effectiveness.MethodsA retrospective review of prospectively collected data of a single vascular surgeon’s experiencewas undertaken. Over a 2-year period a total of 172 procedures were performed with 77involving vascular graft insertion. Procedures were performed in both laminar flow andconventional theatre environments, with allocation randomized via the waiting list to one ofthree weekly scheduled lists. One list was regularly in laminar flow, the remaining 2 listsalternating between conventional and laminar flow theatres. All patients received a uniformanaesthetic & surgical technique, perioperative antibiotics and rehabilitation with a minimumfollow up of 1 year.ResultsA total of 46 grafts were inserted in a conventional theatre and 31 in a laminar flow. 19 patientssuffered postoperative graft infection (25%) of which 9 were diagnosed as deep graft infections.16 infections occurred following operation in a conventional theatre and 3 infections occurringin the laminar flow theatre (p=0.0042) with all 9 deep infections occurring in the conventionaltheatre group. All other risk factors and co-morbidities were comparable between the groups.ConclusionThis study demonstrates conclusively that vascular graft infections occur more commonly innon-laminar flow theatres. Given the principles of vascular grafts and orthopaedic implants arethe same, we conclude that this data strongly suggests laminar flow should be made anessential, not “recommended” augment to routine orthopaedic surgery. This further reinforceshow it would be unethical to undertake an identical study in orthopaedics and should probablyraise similar concerns in vascular surgery.file:///E|/ISTA2010-Abstracts.htm[12/7/2011 3:15:47 PM]