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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, (leekha.surbhi@mayo.edu)
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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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