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Infection risk statistics in joint replacement

Josephine

NURSE DIRECTOR EMERITUS
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The most commonly quoted figures for infection in joint arthroplasty are based upon epidemiological research performed many years ago, with patients being quoted at around 1% for infection. There has been little up-to-date research of a sufficiently large enough cohort of patients to be able to estimate the risks to patients that surgical site infection poses.

A team from New York have used the national inpatient sample between 1998 and 2007 to analyse the surgical site infection (SSI) rates for 412,356 THRs and 784,335 TKRs.

Data were collated to establish infection rates, length of stay and overall episode costs for both groups of patients. Infection rates were much lower than the rates commonly quoted with a 0.36% THR infection rate and a 0.31% TKR infection rate. Patients suffering an SSI were found to have a higher comorbidity burden, higher mortality rate, longer length of stay and higher complication rates. The total cost of inpatient was on average double for patients whose procedure was complicated by an SSI. The researchers were able (given the very large sample size) to establish independent risk factors for infection of male gender, ethnic minority, oncological diagnosis,
coagulopathy, or liver disease and electrolyte disorders.

While this is an extremely powerful study it only reports on inpatient infection rates and no attempt was made to link patient data with readmissions. Consequently while this paints an accurate picture of the first few post-operative days, we would be concerned about the reliability of the quoted infection rates. Most deep infections present early in the post-operative course but often not while an inpatient. While hugely valuable for identifying risk factors, this important paper must be interpreted in the light of its significant limitations.

Poulsides, LA, Arthroplasty 2013; 28:531-536
 

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