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Differences in the Risk Factors for Surgical Site Infection between Total Hip Arthroplasty and Total Knee Arthroplasty in the Korean Nosocomial Infections Surveillance System (KONIS)

Published online by Cambridge University Press:  02 January 2015

Kyoung-Ho Song ,
Eu Suk Kim ,
Young Keun Kim ,
Hye Young Jin ,
Sun Young Jeong ,
Yee Gyung Kwak ,
Yong Kyun Cho ,
Joohon Sung ,
Yeong-Seon Lee  and
Hee-Bok Oh
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Kyoung-Ho Song
Affiliation:
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
Eu Suk Kim
Affiliation:
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
Young Keun Kim
Affiliation:
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
Hye Young Jin
Affiliation:
Infection Control Office, Ajou University Hospital, Suwon, Republic of Korea
Sun Young Jeong
Affiliation:
Infection Control Office, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
Yee Gyung Kwak
Affiliation:
Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
Joohon Sung
Affiliation:
Department of Epidemiology and Institute of Environment and Health, Seoul National University School of Public Health, Seoul, Republic of Korea
Yeong-Seon Lee
Affiliation:
Center for Infectious Diseases, Korea National Institute of Health, Osong, Republic of Korea
Hee-Bok Oh
Affiliation:
Center for Infectious Diseases, Korea National Institute of Health, Osong, Republic of Korea
Tae Kyun Kim
Affiliation:
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
Kyung-Hoi Koo
Affiliation:
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
Eui-Chong Kim
Affiliation:
Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
June Myung Kim
Affiliation:
Division of Infectious Diseases, Yonsei Medical Center, Seoul, Republic of Korea
Tae Yeol Choi
Affiliation:
Department of Laboratory Medicine, Hanyang University Hospital, Seoul, Republic of Korea
Hyo Youl Kim
Affiliation:
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
Hee Jung Choi
Affiliation:
Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
Hong Bin Kim*
Affiliation:
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
*
Department of Internal Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, Republic of Korea, 463-707 (hbkimmd@snu.ac.kr)
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Abstract

Objective.

To compare the characteristics and risk factors for surgical site infections (SSIs) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in a nationwide survey, using shared case detection and recording systems.

Design.

Retrospective cohort study.

Setting.

Twenty-six hospitals participating in the Korean Nosocomial Infections Surveillance System (KONIS).

Patients.

From 2006 to 2009, all patients undergoing THA and TKA in KONIS were enrolled.

Results.

SSI occurred in 161 (2.35%) of 6,848 cases (3,422 THAs and 3,426 TKAs). Pooled mean SSI rates were 1.69% and 2.82% for THA and TKA, respectively. Of the cases we examined, 42 (26%) were superficial-incisional SSIs and 119 (74%) were “severe” SSIs; of the latter, 24 (15%) were deep-incisional SSIs and 95 (59%) were organ/space SSIs. In multivariate analysis, a duration of preoperative hospital stay of greater than 3 days was a risk factor for total SSI after both THA and TKA. Diabetes mellitus, revision surgery, prolonged duration of surgery (above the 75th percentile), and the need for surgery due to trauma were independent risk factors for total and severe SSI after THA, while male sex and an operating room without artificial ventilation were independent risk factors for total and severe SSI after TKA. A large volume of surgeries (more than 10 procedures per month) protected against total and severe SSI, but only in patients who underwent TKA.

Conclusions.

Risk factors for SSI after arthroplasty differ according to the site of the arthroplasty. Therefore, clinicians should take into account the site of arthroplasty in the analysis of SSI and the development of strategies for reducing SSI.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 11 , November 2012 , pp. 1086 - 1093
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

1.Statistics on major surgical procedures in Korea, 2009. National Health Insurance Corporation website, http://www.nhic.or.kr. Accessed December 8, 2011.Google Scholar
2.Zimmerli, W, Trampuz, A, Ochsner, PE. Prosthetic-joint infections. N Engl J Med 2004;351(16):1645–1654.CrossRefGoogle ScholarPubMed
3.Matthews, PC, Berendt, AR, McNally, MA, Byren, I. Diagnosis and management of prosthetic joint infection. BMJ 2009;338:b1773.Google Scholar
4.Steckelberg, JM, Osmon, DR. Prosthetic joint infections. In: Waldvogel, FA, Bisno, AL, eds. Infections Associated with Indwelling Medical Devices. 3rd ed. Washington, DC: ASM, 2000:173–209.Google Scholar
5.Gaynes, RP. Surveillance of nosocomial infections: a fundamental ingredient for quality. Infect Control Hosp Epidemiol 1997;18(7):475–478.CrossRefGoogle ScholarPubMed
6.Peel, TN, Dowsey, MM, Daffy, JR, et al.Risk factors for prosthetic hip and knee infections according to arthroplasty site. J Hosp Infect 2011;79(2):129–133.Google Scholar
7.Brandt, C, Hott, U, Sohr, D, et al.Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery. Ann Surg 2008;248(5):695–700.Google Scholar
8.Kwak, YG, Lee, SO, Kim, HY, et al.Risk factors for device-associated infection related to organisational characteristics of intensive care units: findings from the Korean Nosocomial Infections Surveillance System. J Hosp Infect 2010;75(3):195–199.Google Scholar
9.Choi, HJ. Multicenter surgical site infection surveillance study about prosthetic joint replacement surgery in 2006. Korean J Nosocom Infect Control 2008;13(1):42–50.Google Scholar
10.Kim, ES, Kim, HB, Song, KH, et al.Prospective nationwide surveillance of surgical site infections after gastric surgery and risk factor analysis in the Korean Nosocomial Infections Surveillance System (KONIS). Infect Control Hosp Epidemiol 2012;33(6):572–580.CrossRefGoogle ScholarPubMed
11.Horan, TC, Gaynes, RP, Martone, WJ, et al.CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 1992;20(5):271–274.Google Scholar
12.Song, KH, Kang, YM, Sin, HY, et al.Outcome of cefazolin prophylaxis for total knee arthroplasty at an institution with high prevalence of methicillin-resistant Staphylococcus aureus infection. Int J Infect Dis 2011;15(12):e867–e870.Google Scholar
13.Breier, AC, Brandt, C, Sohr, D, et al.Laminar airflow ceiling size: no impact on infection rates following hip and knee prosthesis. Infect Control Hosp Epidemiol 2011;32(11):1097–1102.Google Scholar
14.Altemeier, WA. Manual on Control of Infection in Surgical Patients. 2nd ed. Philadelphia: Lippincott, 1984.Google Scholar
15.Owens, WD, Felts, JA, Spitznagel, EL Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology 1978;49(4):239–243.Google Scholar
16.Steinberg, JP, Braun, BI, Hellinger, WC, et al.Timing of antimicrobial prophylaxis and the risk of surgical site infections: results from the Trial to Reduce Antimicrobial Prophylaxis Errors. Ann Surg 2009;250(1):10–16.Google Scholar
17.Urquhart, DM, Hanna, FS, Brennan, SL, et al.Incidence and risk factors for deep surgical site infection after primary total hip arthroplasty: a systematic review. J Arthroplast 2010;25(8):1216–1222, e1-e3.Google Scholar
18.Ridgeway, S, Wilson, J, Charlet, A, et al.Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br 2005;87(6):844–850.Google Scholar
19.Meyer, E, Weitzel-Kage, D, Sohr, D, Gastmeier, P. Impact of department volume on surgical site infections following arthroscopy, knee replacement or hip replacement. BMJ Qual Saf 2011;20(12):1069–1074.CrossRefGoogle ScholarPubMed
20.Katz, JN, Losina, E, Barrett, J, et al.Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population. J Bone Joint Surg Am 2001;83-A(11):1622–1629.Google Scholar
21.Berbari, EF, Hanssen, AD, Duffy, MC, et al.Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis 1998;27(5):1247–1254.CrossRefGoogle ScholarPubMed
22.Laffer, RR, Graber, P, Ochsner, PE, Zimmerli, W. Outcome of prosthetic knee-associated infection: evaluation of 40 consecutive episodes at a single centre. Clin Microbiol Infect 2006;12(5):433–439.CrossRefGoogle ScholarPubMed
23.Leekha, S, Sampathkumar, P, Berry, DJ, Thompson, RL. Should national standards for reporting surgical site infections distinguish between primary and revision orthopedic surgeries? Infect Control Hosp Epidemiol 2011;31(5):503–508.Google Scholar
24.Petrosillo, N, Drapeau, CM, Nicastri, E, et al.Surgical site infections in Italian hospitals: a prospective multicenter study. BMC Infect Dis 2008;8:34.Google Scholar
25.Kim, ES, Park, SW, Lee, CS, et al.Impact of a national hospital evaluation program using clinical performance indicators on the use of surgical antibiotic prophylaxis in Korea. Int J Infect Dis 2012;16(3):e187–e192.Google Scholar