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Should National Standards for Reporting Surgical Site Infections Distinguish between Primary and Revision Orthopedic Surgeries?

Published online by Cambridge University Press:  02 January 2015

Surbhi Leekha ,
Priya Sampathkumar ,
Daniel J. Berry  and
Rodney L. Thompson
Surbhi Leekha*
Affiliation:
Divisions of Infectious Diseases, College of Medicine, Mayo Clinic, Rochester, Minnesota
Priya Sampathkumar
Affiliation:
Divisions of Infectious Diseases, College of Medicine, Mayo Clinic, Rochester, Minnesota
Daniel J. Berry
Affiliation:
Orthopedic Surgery, College of Medicine, Mayo Clinic, Rochester, Minnesota
Rodney L. Thompson
Affiliation:
Divisions of Infectious Diseases, College of Medicine, Mayo Clinic, Rochester, Minnesota
*
Divisions of Infectious Diseases, College of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, ([email protected])
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Abstract

Objective.

To compare the surgical site infection (SSI) rate after primary total hip arthroplasty with the SSI rate after revision total hip arthroplasty.

Design.

Retrospective cohort study.

Setting.

Mayo Clinic in Rochester, Minnesota, a referral orthopedic center.

Patients.

All patients undergoing primary total hip arthroplasty or revision total hip arthroplasty during the period from January 1, 2002, through December 31, 2006.

Methods.

We obtained data on total hip arthroplasties from a prospectively maintained institutional surgical database. We reviewed data on SSIs collected prospectively as part of routine infection control surveillance, using the criteria of the Centers for Disease Control and Prevention for the definition of an SSI. We used logistic regression analyses to evaluate differences between the SSI rate after primary total hip arthroplasty and the SSI rate after revision total hip arthroplasty.

Results.

A total of 5,696 total hip arthroplasties (with type 1 wound classification) were analyzed, of which 1,381 (24%) were revisions. A total of 61 SSIs occurred, resulting in an overall SSI rate of 1.1% for all total hip arthroplasties. When stratified by the National Nosocomial Infection Surveillance (NNIS) risk index, SSI rates were 0.5%, 1.2%, and 1.6% in risk categories 0, 1, and 2, respectively. After controlling for the NNIS risk index, the risk of SSI after revision total hip arthroplasty was twice as high as that after primary total hip arthroplasty (odds ratio, 2.2 [95% confidence interval, 1.3-3.7]). In the analysis restricted to the development of deep incisional or organ space infections, the risk of SSI after revision total hip arthroplasty was nearly 4 times that after primary total hip arthroplasty (odds ratio, 3.9 [95% confidence interval, 2.0-7.6]).

Conclusion.

Including revision surgeries in the calculation of SSI rates can result in higher infection rates for institutions that perform a larger number of revisions. Taking NNIS risk indices into account does not eliminate this effect. Differences between primary and revision surgeries should be considered in national standards for the reporting of SSIs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 5 , May 2010 , pp. 503 - 508
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1. StopHospitalInfections.org. Summary of state activity. States with laws requiring hospital-acquired infection reporting. http://www.consumersunion.org/campaigns/learn_more_background/003544indiv.html. Accessed April 25, 2009.Google Scholar
2. Association for Professionals in Infection Control and Epidemiology. HAI reporting laws and regulations, http://www.apic.org/am/images/maps/mandrpt_map.gif. Accessed April 25, 2009.Google Scholar
3.Edmond, MB, Bearman, GM. Mandatory public reporting in the USA: an example to follow? J Hosp Infect 2007;65:182–188.CrossRefGoogle ScholarPubMed
4. National Quality Forum. National Voluntary Consensus Standards for the Reporting of Healthcare-Associated Infection Data. http://www.quali tyforum.org/Publications/2008/03/National_Voluntary_Consensus _Standards_for_the_Reporting_of_Healthcare-Associated_Infection_Data.aspx. Accessed October 10, 2008.Google Scholar
5.Ahnfeit, L, Herberts, P, Malchau, H, Andersson, GB. Prognosis of total hip replacement: a Swedish multicenter study of 4,664 revisions. Acta Orthop Scand Suppl 1990;238:1–26.Google Scholar
6.Berbari, EF, Hanssen, AD, Duffy, MC, et al.Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis 1998;27:1247–1254.CrossRefGoogle ScholarPubMed
7.Wymenga, AB, van Horn, JR, Theeuwes, A, Muytjens, HL, Slooff, TJ. Perioperative factors associated with septic arthritis after arthroplasty: prospective multicenter study of 362 knee and 2,651 hip operations. Acta Orthop Scand 1992;63:665–671.Google Scholar
8.Wilson, J, Charlett, A, Leong, G, McDougall, C, Duckworth, G. Rates of surgical site infection after hip replacement as a hospital performance indicator: analysis of data from the English mandatory surveillance system. Infect Control Hosp Epidemiol 2008;29:219–226.CrossRefGoogle ScholarPubMed
9. Centers for Disease Control and Prevention (CDC). National Healthcare Safety Network (NHSN). Patient Safety Component. Related Material. NHSN Manual: Patient Safety Component Protocols, http://www.cdc.gov/nhsn/psc.html. Accessed March 21, 2008.Google Scholar
10.Berry, DJ, Kessler, M, Morrey, BF. Maintaining a hip registry for 25 years: Mayo Clinic experience. Clin Orthop Relat Res 1997(344):61–68.Google Scholar
11.National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
12.Ercole, FF, Starling, CE, Chianca, TC, Carneiro, M. Applicability of the national nosocomial infections surveillance system risk index for the prediction of surgical site infections: a review. Braz J Infect Dis 2007;11:134–141.Google Scholar
13.Geubbels, EL, Grobbee, DE, Vandenbroucke-Grauls, CM, Wille, JC, de Boer, AS. Improved risk adjustment for comparison of surgical site infection rates. Infect Control Hosp Epidemiol 2006;27:1330–1339.Google Scholar
14.Friedman, ND, Bull, AL, Russo, PL, et al.An alternative scoring system to predict risk for surgical site infection complicating coronary artery bypass graft surgery. Infect Control Hosp Epidemiol 2007;28:1162–1168.CrossRefGoogle ScholarPubMed
15.Anderson, DJ, Chen, LF, Sexton, DJ, Kaye, KS. Complex surgical site infections and the devilish details of risk adjustment: important implications for public reporting. Infect Control Hosp Epidemiol 2008;29:941–946.CrossRefGoogle ScholarPubMed
16.Kurtz, S, Mowat, F, Ong, K, Chan, N, Lau, E, Halpern, M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 2005;87:1487–1497.Google Scholar
17.Kurtz, SM, Ong, KL, Schmier, J, Zhao, K, Mowat, F, Lau, E. Primary and revision arthroplasty surgery caseloads in the United States from 1990 to 2004. J Arthroplasty 2009;24:195–203.Google Scholar