Trends in the Incidence of Surgical Site Infection in The Netherlands

2008 ◽  
Vol 29 (12) ◽  
pp. 1132-1138 ◽  
Author(s):  
Judith Manniën ◽  
Susan van den Hof ◽  
Jan Muilwijk ◽  
Peterhans J. van den Broek ◽  
Birgit van Benthem ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
The Netherlands ◽  
Surgical Site Infection ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Procedure ◽  
Multivariate Logistic Regression Analysis ◽  
Site Infection ◽  
Surveillance Network ◽  
Total Hip

Objective.To evaluate the time trend in the surgical site infection (SSI) rate in relation to the duration of surveillance in The Netherlands.Setting.Forty-two hospitals that participated in the the Dutch national nosocomial surveillance network, which is known as PREZIES (Preventie van Ziekenhuisinfecties door Surveillance), and that registered at least 1 of the following 5 frequently performed surgical procedures for at least 3 years during the period from 1996 through 2006: mastectomy, colectomy, replacement of the head of the femur, total hip arthroplasty, or knee arthroplasty.Methods.Analyses were performed for each surgical procedure. The surveillance time to operation was stratified in consecutive 1-year periods, with the first year as reference. Multivariate logistic regression analysis was performed using a random coefficient model to adjust for random variation among hospitals. All models were adjusted for method of postdischarge surveillance.Results.The number of procedures varied from 3,031 for colectomy to 31,407 for total hip arthroplasty, and the SSI rate varied from 1.6% for knee arthroplasty to 12.2% for colectomy. For total hip arthroplasty, the SSI rate decreased significantly by 6% per year of surveillance (odds ratio [OR], 0.94 [95% confidence interval {CI}, 0.90–0.98]), indicating a 60% decrease after 10 years. Nonsignificant but substantial decreasing trends in the rate of SSI were found for replacement of the head of the femur (OR, 0.94 [95% CI, 0.88–1.00]) and for colectomy (OR, 0.92 [95% CI, 0.83–1.02]).Conclusions.Even though most decreasing trends in the SSI rate were not statistically significant, they were encouraging. To use limited resources as efficiently as possible, we would suggest switching the surveillance to another surgical procedure when the SSI rate for that particular procedure has decreased below the target rate.

scholarly journals Conversion of Failed Hip Resurfacings to Total Hip Arthroplasty- A Favorable Solution with Satisfactory Outcomes

2021 ◽  
Author(s):  
Abdel-hamid A Atalla ◽  
Abdel-hamid ◽  
Bahaa A Kornah ◽  
Mohamed Abdel-AAl ◽  
Abdel-Aleem Soltan
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Surgical Site Infection ◽  
Heterotopic Ossification ◽  
Hip Arthroplasty ◽  
Groin Pain ◽  
Hip Resurfacing ◽  
Site Infection ◽  
Total Hip

Abstract Background: Hip resurfacing had been utilized since the 1950s. The concept favored for young active patients owing to its proposed advantages. Revision rate of hip resurfacing in most national registries nearly 3.5%. Conversion to total hip replacement may be the correct option for old patients and those whose activity levels changed and the need for hip resurfacing no longer required.Purpose: The aim of this study is to assess the mid-term outcomes of converting failed hip resurfacing arthroplsty to total hip arthroplasty. Primary outcomes included improvement of Oxford, WOMAC, Harris and UCLA hip scores. Also; radiological follow-up has been evaluated for component stability or signs of loosening. Secondary outcomes included surgical site infection, residual groin pain, and heterotopic ossification. Most of patients (22 patients (88%) reported relief of pain and good to excellent patient satisfaction. Study design: Prospective case series study.Level of evidence: Therapeutic IV.Patients and Methods:Twenty–five patients (fifteen males) with failed hip resurfacing arthroplasty converted to total hip arthroplasty enrolled in this study. Mean age 56.8 years. Mean time to revision 36.8 months. Indications for revision included: femoral neck fractures (10 cases), femoral neck thinning (3 cases), component loosening (4 cases) component dislocation (2 cases) persistent groin pain and clicking (3 cases) and wear of components (3 cases). Nineteen patients revised both components while remaining six underwent revision of femoral component only. Results:The average duration of follow up was 26.8 months (28-48 months). The study was an intermediate term follow-up. Clinical outcome evaluated through Oxford, WOMAC, Harris and UCLA hip scores. Preoperative scores 21.3, 78.3, 35,7 and 2 respectively improved to 39.8, 11.1, 92.3 and 7 respectively at last follow-up representing statistically significant improvements over pre-operative scores (p < 0.0001 for each score) Radiological follow-up evaluated for component stability or signs of loosening. No cases of neurological, vascular, deep infection or implant failure. There were 3 cases (3%) with complications. one case complicated by surgical site infection with serous drainage for more than seven days and treated with oral antibiotics and daily dressings. One case had residual groin pain, and third case had mild heterotopic ossification. All patients were satisfied particularly by their pain relief. Average post operative Oxford, Harris and WOMAC hip scores were 17.4, 89.8 and 6.1 respec-tively. representing statistically significant improvements over pre operative scores (p < 0.0001 for each score)Conclusions: study shows conversion of hip resurfacing to THA has high satisfaction rates. These results compare favorably with those for revision total hip arthroplasty

Readmissions after Diagnosis of Surgical Site Infection Following Knee and Hip Arthroplasty

2014 ◽  
Vol 35 (2) ◽  
pp. 152-157 ◽  
Author(s):  
Kyle G. Miletic ◽  
Thomas N. Taylor ◽  
Emily T. Martin ◽  
Rahul Vaidya ◽  
Keith S. Kaye
Keyword(s):  
Surgical Site Infection ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Hospital Admissions ◽  
Site Infection ◽  
Median Cost ◽  
Readmission Rates ◽  
Total Hip ◽  
Hip And Knee Arthroplasty

Context.Surgical site infection (SSI) after total hip and knee arthroplasty is a common postoperative complication. We sought to determine readmission rates and costs for total hip and knee arthroplasty complicated by SSI.Design.The Thomson Reuters MarketScan database was searched for patients who underwent knee or hip arthroplasty in 2007. From these data, patients who received a diagnosis of SSI and were readmitted after diagnosis were identified.Setting.A population of 31 to 45 million individuals receiving insurance coverage. Patients who underwent knee or hip arthroplasty who experienced a hospitalization for SSI in the year after surgery were analyzed.Outcome Measures.Total readmission rates and costs per readmission at 30, 60, and 90 days and 1 year after diagnosis of SSI.Results.Of the 76,289 case patients with hip or knee replacement in 2007, 1,026 (1.3%) had a hospitalization for SSI within the year after surgery. Among these patients, 310 (30.2%) were subsequently rehospitalized in the year after initial hospitalization specifically due to SSI-related issues. These rehospitalizations were associated with a mean hospital stay of 7.4 ± 11.4 days and a median cost of $20,001 (interquartile range [IQR], $14,057-$30,551). A total of 517 subjects had a subsequent “all-cause” hospitalization during the year after SSI. These rehospitalizations were associated with a mean hospital stay of 6.4 ± 10.4 days and a median cost of $19,870 (IQR, $13,913-$29,728).Conclusions.Readmissions during the year after SSI diagnosis accounted for 1,072 hospital admissions and cost over $25.5 million. These readmissions are costly and might be a future target for decreased reimbursement.

Wound complications after total hip arthroplasty: a prospective, randomised controlled trial comparing staples with sutures

2020 ◽  
pp. 112070002093907
Author(s):  
Wouter H Mallee ◽  
Anne E Wijsbek ◽  
Matthias U Schafroth ◽  
Julius Wolkenfelt ◽  
Dominique C Baas ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Surgical Site Infection ◽  
Hip Arthroplasty ◽  
Wound Closure ◽  
Wound Complications ◽  
Site Infection ◽  
Total Hip ◽  
Significant Difference ◽  
Wound Discharge ◽  
Randomised Controlled

Objective: Does the use of staples or sutures for wound closure have a lower surgical site infection rate in patients receiving primary total hip arthroplasty (THA)? Design: Prospective, randomised controlled multicentre trial. Methods: 535 patients undergoing THA were included and randomised into 2 groups: 268 wounds were closed with staples, and 267 with sutures. Primary outcome was surgical site infection (SSI). Secondary outcomes were prosthetic joint infection (PJI), other wound complications (dehiscence, necrosis and prolonged drainage) and duration of admittance. Follow-up occurred at 2, 6, and 12 weeks, and at 1 year. Results: There were no significant demographic differences between the 2 groups. SSI occurred more frequently when wounds were closed with staples (4% compared to 1% with sutures; OR 2.8; CI, 0.885–0.952; p = 0.057). SSI was treated with oral antibiotics. The staples group showed significantly more wound complications (17% compared to 5%; OR 3.943, CI 2.073–7.498; p = 0.000). Wound discharge was significantly prolonged in the staples group ( n = 40, compared to n = 12 in the sutures group; OR 3.728; CI, 1.909–7.281; p = 0.000). There was no significant difference in PJI ( p = 0.364). Conclusions: In this large RCT comparing staples with sutures after THA, the use of staples is associated with a nearly 3 times greater risk of SSI (OR 2.8; p = 0.057). Staples significantly prolong wound discharge. The use of sutures for wound closure after THA is advised. Trial registration: Staples Or Sutures trial (S.O.S. trial) http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3946 , NTR3946.

scholarly journals Assessment of risk factors for early-onset deep surgical site infection following primary total hip arthroplasty for osteoarthritis

2021 ◽  
Vol 6 (9) ◽  
pp. 443-450
Author(s):  
Jonathan Bourget-Murray ◽  
Rohit Bansal ◽  
Alexandra Soroceanu ◽  
Sophie Piroozfar ◽  
Pam Railton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Surgical Site Infection ◽  
Infection Rate ◽  
Hip Arthroplasty ◽  
Early Onset ◽  
Site Infection ◽  
Total Hip ◽  
Deep Surgical Site Infection ◽  
Primary Total Hip Arthroplasty

Abstract. The aim of this study was to determine the incidence, annual trend, and perioperative outcomes and identify risk factors of early-onset (≤90 d) deep surgical site infection (SSI) following primary total hip arthroplasty (THA) for osteoarthritis. We performed a retrospective study using prospectively collected patient-level data from January 2013 to March 2020. The diagnosis of deep SSI was based on the published Centre for Disease Control/National Healthcare Safety Network (CDC/NHSN) definition. The Mann–Kendall trend test was used to detect monotonic trends. Secondary outcomes were 90 d mortality and 90 d readmission. A total of 22 685 patients underwent primary THA for osteoarthritis. A total of 46 patients had a confirmed deep SSI within 90 d of surgery representing a cumulative incidence of 0.2 %. The annual infection rate decreased over the 7-year study period (p=0.026). Risk analysis was performed on 15 466 patients. Risk factors associated with early-onset deep SSI included a BMI > 30 kg m−2 (odds ratio (OR) 3.42 [95 % CI 1.75–7.20]; p<0.001), chronic renal disease (OR, 3.52 [95 % CI 1.17–8.59]; p=0.011), and cardiac illness (OR, 2.47 [1.30–4.69]; p=0.005), as classified by the Canadian Institute for Health Information. Early-onset deep SSI was not associated with 90 d mortality (p=0.167) but was associated with an increased chance of 90 d readmission (p<0.001). This study establishes a reliable baseline infection rate for early-onset deep SSI after THA for osteoarthritis through the use of a robust methodological process. Several risk factors for early-onset deep SSI are potentially modifiable, and therefore targeted preoperative interventions of patients with these risk factors is encouraged.

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