Surgical site infection in hip arthroplasty in a 10-year follow-up prospective study: Risk and factors associated.

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.

Surgical site infection incidence and risk factors in knee arthroplasty: A 9-year prospective cohort study at a university teaching hospital in Spain.

BACKGROUND: Surgical site infection (SSI) is one of the complications posed by knee replacement surgery. Hospital-based infection surveillance systems may provide indicators of improvement and allow the characterization of risk factors critical to reduce infection. The aims of this study were to compare the incidence of SSI in our center with rates in the Madrid Region, Spain, and the United States, and to evaluate any possible SSI-related risk factor in knee replacement surgery. METHODS: All patients who underwent knee replacement surgery at a tertiary hospital in 2008-2016 were included. SSI was defined according to Centers for Disease Control and Prevention criteria. Infection rate was calculated. The association between risk factors and SSI incidence was assessed by reference to odds ratio (OR) with multivariate analysis. RESULTS: The study population (n = 1969) had a global SSI risk of 1.0%. We found a declining trend in the follow-up period, from an SSI risk of 1.8% in 2009 to 0.4% in 2016. Independent risk factors included hair removal (OR: 3.09, 95% confidence interval [CI]: 1.27-7.50) and National Healthcare Safety Network risk index ≥ 2 (OR: 9.37, 95% CI: 2.90-30.26). CONCLUSION: This study identified risk factors that showed the necessity to strictly comply with wound decontamination and patient preparation protocols, reduce surgery duration, and identify patients who require comprehensive monitoring.

Antibioterapia profiláctica en la artroplastia de cadera. Estudio de cohorts / Prophylactic antibiotherapy in hip arthroplasty. Cohort study

Introducción: La infección de herida quirúrgica (IHQ) es la principal causa de infección nosocomial en pacientes quirúrgicos, siendo la profilaxis antibiótica uno de los factores más importantes para su prevención. En este trabajo se evaluó la adecuación de la profilaxis antibiótica en la artroplastia de cadera de acuerdo a la pauta establecida en nuestro centro y el efecto en la IHQ. Material y métodos. Se realizó un estudio de cohortes prospectivo entre enero de 2011 y diciembre de 2016. Se evaluó el grado de adecuación de la profilaxis antibiótica en cirugía de artroplastia de cadera. Se estudió la incidencia de IHQ tras un periodo máximo de 90 días. El efecto de la inadecuación de la profilaxis antibiótica en la incidencia de IHQ se evaluó con el riesgo relativo (RR) ajustado mediante un modelo de regresión logística. Resultados. Se incluyeron un total de 681 pacientes. La incidencia global de IHQ fue del 4% (IC 95%: 2,5-5,5). La profilaxis antibiótica se administró en el 99% de los casos, con una adecuación al protocolo del 74%. La causa más frecuente de inadecuación fue la duración de la profilaxis, con un 22,2% (149 pacientes). El efecto de la inadecuación de la profilaxis sobre la incidencia de infección fue de RR ajustado =0,47; IC95%: 0,19-1,17) (p>0,05). Conclusiones. La adecuación de la profilaxis antibiótica fue alta. No se encontró asociación entre adecuación de la profilaxis y la incidencia de infección en artroplastia de cadera. La vigilancia de la infección quirúrgica permite medir su incidencia y evaluar sus factores de riesgo

Introduction. The surgical site infection is the main cause of nosocomial infection in surgical patients, being antibiotic prophylaxis one of the most important factors for preventing it. This study evaluates adequacy of antibiotic prophylaxis in hip arthroplasty surgery as well as its effect on preventing surgical site infection. Material and methods. A prospective cohort study was carried out from January 2011 to December 2016. We assessed the degree of adequacy of antibiotic prophylaxis in hip arthroplasty. Incidence of surgical site infection was studied after a maximum incubation period of 90 days. In order to assess the effect of inadequate prophylaxis on surgical site infection we used the relative risk adjusted with a logistic regression model. Results. We studied 681 patients. Incidence of surgical site infection was 4% (95% CI 2.5-5.5). Antibiotic prophylaxis was administered in 99% of cases, with an overall protocol adequacy of 74%. The main cause of non-compliance was the length of prescription (22.2%; 149 patients). The effect of inadequate prophylaxis on surgical site infection was RR adjusted =0.47; 95%CI 0.19-1.17, (p>0.05). Conclusions. Adequacy of antibiotic prophylaxis was high. No relationship between prophylaxis adequacy and incidence of surgical site infection was founded. Surveillance allows us to assess surgical site infection and risk factors