Surgical site infection in hip arthroplasty in a 10-year follow-up prospective study: Risk and factors associated - 18/11/20
Highlights |
• | The increased demand for hip arthroplasty means a growing number of postsurgical complications. |
• | Surgical site infection is the second most frequent complication after prosthetic loosening. |
• | Hospital-based infection surveillance is an important component for of surgical site infection control. |
• | Timing of surgery (elective or urgent/unplanned) influences the infection risk in orthopedic surgery. |
• | Operative times, blood transfusion or patient preparation before surgery, are key for infection prevention. |
Résumé |
Background |
The increased demand for hip arthroplasty means a growing number of postsurgical complications. This study aims to assess the risk of surgical site infection (SSI) in a teaching hospital; develop regional, national and international external comparisons; and evaluate SSI-related risk factors, particularly according to the timing of surgery (urgent/unplanned or elective).
Methods |
Prospective cohort study from January 2008 to December 2018. Patients were followed up to 90 days after surgery. Primary endpoint was SSI incidence according to the Centers for Disease Control and Prevention criteria. Multivariate analysis was conducted to find independently associated SSI risk factors. The association between risk factors and SSI incidence was assessed by reference to odds ratio (OR). Analyses were also performed among urgent/unplanned and elective patients to identify whether SSI risk factors differed between groups.
Results |
The study population (n = 1,808) has an overall SSI rate of 3.0% (95% confidence interval [CI]: 2.4-3.9). Timing of surgery caused an effect modification, so surgery duration> 75th percentile (OR: 3.8; 95% CI: 1.5-9.8) and inadequate preparation (OR: 3.3; 95% CI: 1.1-10.0) were independent risk factors in the urgent/unplanned group; National Healthcare Safety Network risk index≥ 2 (OR: 6.3; 95% CI: 0.1-19.2) and transfusion (OR: 3.6; 95% CI: 1.1-11.9) in the elective group.
Conclusions |
Hospital infection surveillance systems allow identifying risk factors susceptible to change. Characterization of factors that caused an effect modification is key to identify areas of quality improvement, including reducing operating times, preventing perioperative blood transfusion, or improving patient preparation before surgery.
Le texte complet de cet article est disponible en PDF.Key Words : Hip replacement arthroplasty, Surgical wound infection, Cohort study, Infection control, Risk factor
Plan
Financial support: The authors thank the European Regional Development Fund (ERDF) and the Health Research Fund (Fondo de Investigación Sanitaria/FIS) supporting the research projects PI11/01272 and PI14/01136 which enabled the completion of this study. |
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The study was approved by the center Ethics Committee and Research Board. |
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Potential conflicts of interest: All authors report no conflicts of interest relevant to this article. |
Vol 48 - N° 12
P. 1437-1444 - décembre 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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