Surgical site infections in oncologic orthopaedic prosthetics surgery.

BACKGROUND: Literature reports an incidence of surgical site infections (SSIs) in oncological patients undergoing prosthetic replacement between 8% and 35% after first implantation and 43% after revision. The purpose of this retrospective study, conducted at the oncologic orthopaedic unit of G. Pini Orthopaedic Hospital in Milan, was to evaluate: - number of SSIs in oncological megaprosthetic reconstruction between 2008 and 2011, - possible risk factors associated with the onset of SSIs, - antibiotic prophylaxis applied. DESIGN AND METHODS: We reviewed medical records of patients who underwent megaprosthetic reconstruction and collected data on whole treatment and follow up after discharge, focusing on possible risk factors implied in the onset of SSIs such as patient characteristics, site of surgery, duration of surgery, number of persons in the operating room, size of resection, antibiotic prophylaxis. We recorded every SSI which met the criteria set by the Hospital in Europe Link for Infection Control through Surveillance (HELICS) protocol. RESULTS: One-hundred and eleven surgeries were evaluated. Administration of prophylaxis was generally recorded and continued postoperatively for an average of 18.89 days, often depending on the length of the post-surgical stay. Mean duration of surgery was 254 minutes with an average of 7 persons attending the operating room. We recorded 6 SSIs.

To measure, evaluate and improve: four years long health records self-control activity at G. Pini Orthopedics Institute.

BACKGROUND: A health record, when properly handled, can be considered in all respects as an important tool that tracks the course of hospitalization, clinical aspects and the commitment of resources employed in the execution of the episode itself. METHODS: Lombardy Region has established, since 2009, that each hospital carry out a self-assessment of their documentation. The objective of self-control is to monitor the completeness and accuracy of documentation and to highlight the congruence in order to implement corrective activities to reduce the inappropriateness. RESULTS: The four years of self-control activities carried out in our Institute show that following the implementation of a supervisory and monitoring system, it was possible to report a statistically significant difference between the percentage of records deemed to comply in the first survey year (2009) and the last year considered (2012). It passes, that is, from 2.9% of conforming clinical records to 68.8% that do not conform. CONCLUSIONS: This trend is suggestive in confirming, as a whole, the effectiveness of internal controls, structured and repeated over time, which evaluate the completeness of the documentation and generate the appropriate corrective actions.