Article

Surgical site infections in orthopedic patients: prospective cohort study.

Ljiljana Markovic-Denic, Institute of Epidemiology, School of Medicine, Visegradska 26, 11000 Belgrade, Serbia, .
Croatian Medical Journal (Impact Factor: 1.25). 02/2008; 49(1):58-65. DOI: 10.3325/cmj.2008.1.58
Source: PubMed

ABSTRACT To estimate the incidence rate and risk factors of surgical site infections in the orthopedic wards in a major teaching hospital in Serbia.
A 6-month prospective cohort study, with 30 days of patient follow-up after surgery, was conducted at the teaching hospital in Belgrade. We collected patients' basic demographic data and data on underlying disease status, surgical procedures, preoperative preparation of patients, and antibiotic prophylaxis. The National Nosocomial Infections Surveillance (NNIS) risk index was computed for each patient. Descriptive and logistic regression analyses were performed to determine risk factors for surgical site infections.
Assessment of 277 patients after operation revealed surgical site infection in 63 patients. In 3 (4.8%) of them, surgical site infections were detected after hospital discharge. The overall incidence rate of surgical site infections was 22.7% (95% confidence interval [95% CI], 17.5-29.1). The incidence increased from 13.2% in clean wounds to 70.0% in dirty wounds. The rates of surgical site infection for the NNIS risk index classes 0 to 3 were 8.1% (13 of 161), 36.4% (32 of 88), 63.0% (17 of 27), and 100% (1 of 1) (P<0.001; chi2 test). Multivariate logistic regression analysis identified the following independent risk factors for surgical site infections: greater number of persons in the operating room (odds ratio [OR], 1.28; 95% CI, 1.02-1.60), contaminated or dirty wounds (OR, 12.09; 95% CI, 5.56-26.28), and American Society of Anesthesiologists' (ASA) score >2 (OR, 3.47; 95% CI, 1.51-7.95). In patients who were shaved with a razor, the period of 12 or more hours between shaving and intervention was also an independent risk factor (OR, 2.77; 95% CI, 1.22-6.28).
There is a high incidence of surgical site infections in orthopedic patients in Serbia in comparison with developed countries and some developing countries. Points for intervention could be reduction of personnel during surgery, better treatment of wounds, decreasing ASA score, and reduction of the time between surgical site shaving and the intervention.

0 Bookmarks
 · 
263 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Data of hospitalizations for THA or TKA were analyzed for each year between 1998 and 2007 from the National Inpatient Sample. Demographics, comorbidities, incidence of morbidity and mortality, length of hospital stay (LOS), and overall cost were compared for infected and non-infected patients. Perioperative SSI rates were 0.36% for THA and 0.31% for TKA (412,356 and 784,335 patient entries, respectively). Patients with SSI had a significantly higher overall comorbidity burden, higher perioperative mortality rates, longer length of stay, and higher complication rates. Average cost of in-hospital care was double for SSI versus non-SSI patients. Independent risk factors for perioperative SSI included male gender, minority race, a diagnosis for cancer, liver disease, coagulopathies, fluid and electrolyte disorders, congestive heart failure, and pulmonary circulatory disease. Data relied on coded information and could not differentiate between superficial or deep infection, or capture patients readmitted for SSI, and therefore may have underestimated the true incidence of SSI.
    The Journal of arthroplasty 11/2012; · 1.79 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Reoperation secondary to surgical site infections can be a devastating complication in orthopaedic surgery. Infection rates in the ambulatory setting have been reported to be lower than those cited in a hospital setting. However, a direct comparative analysis of infection rates of orthopaedic procedures performed in a single specialty ambulatory surgical center (ASC) versus a multi-specialty ASC has, to our knowledge, not been performed. Methods Four surgeons performed more than 10,000 orthopaedic surgeries in a multispecialty and single specialty ambulatory setting over 8 years. These procedures were reviewed for postoperative deep infection within one year of initial operation. Results The post-surgical deep infection rate in a multi-specialty ASC was 0.81% in 2867 operations compared with a rate of 0.38% in 7311 operations performed in a single specialty ASC (p = 0.007). Conclusions This study demonstrated that the rate of infection leading to reoperation was significantly lower in a single specialty ambulatory surgery setting as opposed to one accommodating multiple specialties.
    Journal of Orthopaedics. 01/2013; 10(3):111–114.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Surgical site infection (SSI) is the most common complication following surgical procedures. The aim of this study was to determine the incidence and associated risk factors of SSI in orthopedic patients admitted in a tertiary care center. Data were collected which focused on demographic details, lifestyle factors, diagnosis, surgical procedure, duration of surgery, prophylactic antibiotics, postoperative antibiotics and comorbidity obtained from the patients hospital records. Univariate analysis and multinomial logistic regression tests were performed to identify independent risk factors for orthopedic incisional SSIs. The overall rate of SSI was 2.1 %. Univariate analysis showed diabetes, smoking and duration of hospital stay to be significantly associated with patients in whom SSI developed than in uninfected control patients. Independent risk factors for SSI that were identified by multinomial logistic regression were diabetes (OR 3.953) and smoking (OR 38.319). Diabetes and smoking were independent risk factors for SSIs. Therefore, it is recommended to tightly regulate blood glucose levels and stop smoking to reduce the SSIs.
    European Journal of Orthopaedic Surgery & Traumatology 05/2014; · 0.18 Impact Factor

Full-text (2 Sources)

View
21 Downloads
Available from
May 21, 2014