Preoperative infection risk assessment in hip arthroplasty a matched-pair study of the reliability of 3 validated risk scales (original) (raw)
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Risk Factors for Surgical Site Infection after Hip Arthroplasty: A Multicentric Study
Surgical Science, 2016
The objective of this study is to answer three main questions: What is the risk of wound infection for patients undergoing hip arthroplasty? What are the main etiologicagents of surgical site infection (SSI)? What are the risk factors most associated with surgical site infection? Method: This was a multicentric, retrospective cohort study which analyzed data collected in five general hospitals in Belo Horizonte, Brazil, between the period of January 2009 and December 2013. The continuous parameters studied were age, length of hospital stay before surgery, duration of surgery, number of professionals at surgery and number of hospital admissions. Categorical variables were surgical wound classification (clean, clean contaminated, contaminated, dirty/infected), American Society of Anesthesiologists (ASA) score (I, II, III, IV, V), type of surgery (elective, emergency), general anesthesia (yes, no), prophylactic antibiotic (yes, no), trauma surgery (yes, no) and Nosocomial Infections Surveillance (NNIS) risk index (IRIC = 0, 1, 2, 3). Results: Estimated SSI risk was 3.2% (95% C.I. = 2.6% to 4.1%) and risk of osteomyelitis was 0.6% (95% C.I. = 0.4% to 1.1%). ASA score > 2, general anesthesia, length of hospital stay before surgery higher than four days, more than two professionals at surgical field and duration of surgery higher than five hours were risk factors for SSI after hip prosthesis (p < 0.05). The final multiple logistic regression analysis indicated that the modified NNIS risk was independently associated with surgical site infection after arthroplasty of hip. Conclusion: Despite the modified NNIS index being a risk factor for SSI, none of its independent variables was statistically significantly in the logistic model (p > 0.100). Each modified NNIS risk category increased the chance of a patient being infected by almost three times, when compared with the previous category (OR = 2.82; p = 0.011).
Clinical Orthopaedics and Related Research®, 2013
Background Diagnosis of periprosthetic joint infection (PJI) can be difficult in the early postoperative period after total hip arthroplasty (THA) because normal cues from the physical examination often are unreliable, and serological markers commonly used for diagnosis are elevated from the recent surgery. Questions/purposes The purposes of this study were to determine the optimal cutoff values for erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), synovial fluid white blood cell (WBC) count, and differential for diagnosing PJI in the early postoperative period after primary THA. Methods We reviewed 6033 consecutive primary THAs and identified 73 patients (1.2%) who underwent reoperation for any reason within the first 6 weeks postoperatively. Thirty-six of these patients were infected according to modified Musculoskeletal Infection Society criteria. Mean values for the diagnostic tests were compared between groups and receiver operating characteristic curves generated along with an area under the curve (AUC) to determine test performance and optimal cutoff values to diagnose infection. Results The best test for the diagnosis of PJI was the synovial fluid WBC count (AUC = 98%; optimal cutoff value 12,800 cells/lL) followed by the CRP (AUC = 93%; optimal cutoff value 93 mg/L), and synovial fluid differential (AUC = 91%; optimal cutoff value 89% PMN). The mean ESR (infected = 69 mm/hr, not infected = 46 mm/hr), CRP (infected = 192 mg/L, not infected = 30 mg/L), synovial fluid WBC count (infected = 84,954 cells/lL, not infected = 2391 cells/lL), and differential (infected = 91% polymorphonuclear cells [PMN], not infected = 63% PMN) all were significantly higher in the infected group. Conclusions Optimal cutoff values for the diagnosis of PJI in the acute postoperative period were higher than those traditionally used for the diagnosis of chronic PJI. The serum CRP is an excellent screening test, whereas the synovial fluid WBC count is more specific. Level of Evidence Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
The Scientific World Journal, 2015
Surgical site infections (SSI) following total hip arthroplasty (THA) have a significantly adverse impact on patient outcomes and pose a great challenge to the treating surgeon. Therefore, timely recognition of those patients at risk for this complication is very important, as it allows for adopting measures to reduce this risk. This review discusses literature reported risk factors for SSI after THA. These can be classified into patient-related factors (age, gender, obesity, comorbidities, history of infection, primary diagnosis, and socioeconomic profile), surgery-related factors (allogeneic blood transfusion, DVT prophylaxis and coagulopathy, duration of surgery, antibiotic prophylaxis, bearing surface and fixation, bilateral procedures, NNIS index score, and anesthesia type), and hospital-related factors (duration of hospitalization, institution and surgeon volume, and admission from a healthcare facility). All these factors are discussed with respect to potential measures that ...
(ii) The prevention of infection in total hip arthroplasty
Orthopaedics and Trauma, 2009
infection after total hip arthroplasty (tha) can lead to pain, decreased function, dislocation and lengthy revision operations over a protracted period of time. We must also consider the psychological impact on the patient and the consequent dissatisfaction with the operation. Modern surgical techniques and technology have contributed significantly to reductions in infection rates, using principles that are firmly based on the observations of pioneers such as pasteur and lister from the mid nineteenth century. this paper presents an evidence based review of techniques used to reduce the risk of infection during total hip arthroplasty. early and contemporary methods are discussed along with the basis for their use.
Journal of Clinical Practice and Research, 2023
Objective: Prosthetic joint infections (PJIs) can lead to extended hospital stays, necessitate additional surgeries, and require antimicrobial treatment, thereby increasing costs and causing significant morbidity. This study aims to ascertain surgeon-specific infection rates and identify risk factors associated with PJIs. Materials and Methods: This research was conducted with two study arms between January 1, 2017, and February 28, 2019. In the first arm, all cases undergoing primary total knee and hip arthroplasty by the same surgeon were prospectively included and monitored for the development of PJIs. In the second arm, all patients admitted to the same surgeon due to PJI were included. Results: The first arm comprised 152 patients, of whom five developed PJIs (3.2%). Risk factors for PJI development included diabetes mellitus (p=0.030), rheumatoid arthritis (p=0.014), superficial surgical wound infections in the same joint (p=0.001), and postoperative hematomas (p=0.008). In the second arm, 23 patients with PJIs were included. Gram-positive microorganisms (84.6%) were the most frequently isolated pathogens. The overall treatment success rate stood at 76%, with a treatment success rate of 72.2% for patients receiving daptomycin. Conclusion: Effective measures such as perioperative glycemic control, regulation of immunosuppressive drugs, management of anticoagulant therapy, postoperative wound care by trained personnel, adherence to infection control protocols, and tailoring of PJI treatments based on local surveillance data are crucial for preventing PJIs and achieving treatment success.
Hip arthroplasty : Incidence and risk factors for surgical site infection
2018
Background: The number of surgical procedures for total hip arthroplasty has increased worldwide, in a direct proportion to the increase in life expectancy of the population. Surgical site infection is the main complication, with several related factors for its occurrence. The objective of this study was to evaluate the incidence of surgical site infection in patients undergoing elective total hip arthroplasty in a tertiary hospital in Brazil, and to identify possible risk factors involved in surgical site infections within the context of Brazilian healthcare. Methods: A total of 130 patients who have undergone total hip arthroplasty, performed by two surgeons, between June of 2015 and April of 2017 were studied. The Cox regression model was used to identify which covariates among those surveyed influenced the follow-up time, and the hazard ratio was calculated. Results: The incidence of SSI within 90 days after surgery was 5.4%, with all identified infections classified as superfic...