The cost of infection in hip arthroplasty: a matched case-control study. / El coste de la infección en artroplastia de cadera: estudio de casos y controles emparejado.

OBJECTIVE: Surgical site infection (SSI) represents 30% of all causes of health care-associated infection (HAI) and is one of the most dreaded complications in surgical patients. We estimated the excess direct costs of SSI using a matched nested case-control study in acute-term care at Ramon y Cajal University Hospital in Spain. MATERIAL AND METHOD: Cases were patients who developed a first episode of SSI according to the criteria established by the CDC's National Healthcare Safety Network. Controls were matched to cases in 1:1 ratio taking into account the American Society of Anesthesiologists score, age, sex, surgery date, and principal diagnosis. RESULTS: This study found that infection in hip replacement increased direct costs by 134%. Likewise, the excess cost due to the infections caused by methicillin resistant Staphylococcus aureus was 69% higher than the excess cost attributable to infections caused by other microorganisms. CONCLUSIONS: SSI after hip replacement continues to be a costly complication from the hospital perspective. Costs due to SSI can be used to prioritise preventive interventions to monitor and control HAI.

Incidencia y factores asociados a la infección de localización quirúrgica tras artroplastia de cadera / Incidence and associated factors of surgical site infections after hip arthroplasty

Introducción. La infección de localización quirúrgica (ILQ) posterior a artroplastia de cadera es la complicación más temida causando hospitalización prolongada, incremento de morbilidad, mortalidad y altos costes. La identificación de los factores implicados en su aparición puede orientar intervenciones para la reducción del riesgo de infección. Material y métodos. Los datos de ILQ y sus factores de riesgo fueron prospectivamente recolectados por el sistema de vigilancia de infección asociada a la atención sanitaria INCLIMECC (Indicadores Clínicos de Mejora Continua de la Calidad), a partir de 3.067 procedimientos de artroplastia de cadera realizados en el Hospital Universitario Ramón y Cajal entre octubre de 1999 y diciembre de 2009. Análisis de regresión logística binaria multivariable con el software SPPS versión 15.0 para Windows fue utilizado para la construcción de un modelo predictivo de ILQ. Resultados. La incidencia global de ILQ fue de 2,71 casos por cada 100 intervenciones. En el análisis univariable, la mayoría de los factores analizados estuvieron asociados al riesgo de infección articular. El análisis de regresión logística multivariable sólo identificó tres factores independientemente asociados a ILQ: edad, estancia preoperatoria e índice NHSN (p<0,05). Conclusiones. Aunque el índice NHSN y la estancia preoperatoria son potenciales marcadores de la presencia de otros factores para ILQ como diabetes mellitus, obesidad, neoplasia y artritis reumatoide, el análisis de éstos por separado podría aumentar el poder predictivo del modelo multivariable (AU)

Introduction. Prosthetic joint infection after hip arthroplasty is the most feared complication and is responsible for prolonged hospitalisation and an increased risk of morbidity and mortality. To identify the factors involved in its onset may lead to interventions to reduce the risk of infection. Material and methods. We prospectively reviewed data collected from the health care infection surveillance system (INCLIMECC) on 3067 hip arthroplasties undertaken in the Ramon y Cajal University Hospital between October 1999 and December 2009. Multivariate analysis was performed using logistic binary regression to create mathematical models to predict joint infection after hip arthroplasty. Results. The overall incidence of joint infection after hip arthroplasty was 2.71%. Unadjusted univariate analysis showed multiple variables associated with joint infection. After multivariable logistic regression analysis, we found the following independent predictors: age, days of hospitalisation prior to the intervention and risk index of the National Healthcare Safety Network (NHSN) (p<.05). Conclusions. NHSN risk index and the days of hospitalisation prior to the intervention are associated to other risk factor of joint infection after hip arthroplasty, such as Diabetes Mellitus, obesity and rheumatoid arthritis. Nevertheless is important to analyse these factors separately to increase the predictive power of the multivariate model (AU)

[Factors associated to admission to Intensive Care in patients hospitalized due to pandemic Influenza A/H1N1 2009]. / Factores asociados a ingreso en unidad de cuidados intensivos en pacientes hospitalizados por Influenza pandémica A/H1N1 2009.

OBJECTIVE: The present study explores the possible factors related to severe cases of pandemic flu. DESIGN: A retrospective cohort study was conducted in patients hospitalized with Influenza A/H1N1 2009 during the pandemic period. SETTING: Ramon y Cajal University Hospital (Madrid, Spain). PATIENTS: All hospitalized patients with positive RT-PCR (real-time polymerase chain reaction) for Influenza A/H1N1 2009 virus. MAIN VARIABLES: The main variables collected were: history of risk factors for severe Influenza, history of immunization, clinical presentation, laboratory tests, chest X-ray report, administration of antiviral treatment, and hospital stay. RESULTS: The median age of the 100 cases was 38 years (range 4 months to 80 years). Seventy-seven percent of the patients had at least one risk factor. Asthma was the most common factor among patients younger than 18 years, versus smoking in the older subjects. Antiviral therapy was initiated a median time of three days (range 0 to 18 days) after the onset of illness. Nineteen percent of the patients were admitted to Intensive Care, and 2% died. Metabolic disease and abnormal chest X-ray findings were factors associated to admission to the ICU. CONCLUSION: As in other studies, abnormal chest X-ray findings upon admission and metabolic disease were related to poor outcomes of 2009 pandemic Influenza A (H1N1) infection in our patients.