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Sumi S, Takegami Y, Tokutake K, Nakashima H, Mishima K, Takatsu T, Imagama S. Risk factors of periprosthetic joint infection after hemiarthroplasty for displaced femoral neck fracture in the elderly: Analysis of 1619 cases in the multicenter database. Injury 2024; 55:111603. [PMID: 38761711 DOI: 10.1016/j.injury.2024.111603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/25/2024] [Accepted: 05/05/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE This multicenter retrospective study focuses on understanding the incidence, causative bacteria, and risk factors for Periprosthetic Joint Infection (PJI) following hemiarthroplasty in elderly patients with displaced femoral neck fractures (FNF). METHODS From 2016 to 2020, 1,619 patients were diagnosed with displaced FNFs and treated surgically across 11 centers. After exclusions, 1,438 patients (399 men and 1,039 women) were included in the study, averaging 82.1 years in age and 20.2 kg/m² in BMI, observed over 25.7 months on average. Data on demographics, medical history, surgical details, and complications were described. RESULTS PJI occurred in 20 of the 1438 patients (1.4%). The causative organism was methicillin-susceptible Staphylococcus aureus in 6 patients and methicillin-resistant S. aureus in 6 patients. In patients' backgrounds, the average age was slightly higher in the non-PJI group (82.1 years) compared to the PJI group (80.4 years). There was a higher percentage of males in the PJI group (45%) than in the non-PJI group (27.5%). Drug history showed that the prevalence of anticoagulant use in the PJI group was 25%. Peripheral vascular disease and diabetes mellitus were more prevalent in the PJI group. Most patients in both groups were independent in daily activities. The blood transfusion rate was significantly higher in the PJI group (50%) than in the non-PJI group (23.8%). Notably, the incidence of hematoma was higher in the PJI group (40%). CONCLUSION This multicenter retrospective study demonstrates a low incidence (1.4%) of PJI in elderly patients undergoing hemiarthroplasty for FNF, primarily due to Staphylococcus aureus. Increased usage of antiplatelets and anticoagulants, as well as comorbidities related to atherosclerosis, like peripheral vascular disease and diabetes mellitus, were observed in patients with PJI. Additionally, these patients experienced higher rates of blood transfusion and postoperative hematomas, highlighting the need for careful management. It should be noted, however, that this finding is a conclusion limited by study design issues, including the retrospective design, small PJI sample size, and variability in treatment approaches.
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Affiliation(s)
- Satoshi Sumi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Katsuhiro Tokutake
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichi Mishima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuro Takatsu
- Department of Orthopaedic Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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de Haan E, Roukema GR, van Rijckevorsel VAJIM, Kuijper TM, Jong LD. Risk factors for prosthetic joint infections after hemiarthroplasty of the hip following a femoral neck fracture. Injury 2024; 55:111195. [PMID: 38039635 DOI: 10.1016/j.injury.2023.111195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/24/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE The primary aim of this study was to identify risk factors and validate earlier reported risk factors for Prosthetic Joint Infection (PJI) after hemiarthroplasty. The secondary aim was to assess peri‑operative clinical outcomes, adverse events and mortality rates in PJI patients after hemiarthroplasty. METHODS A prospective hip fracture database was used to obtain data for this observational cohort study. Patients who underwent hemiarthroplasty between 2011 and 2021 were included. A PJI was diagnosed by the Musculoskeletal Infection Society criteria. Univariable and multivariable analyses were performed to identify factors highly associated with a PJI. RESULTS In total, 2044 patients were analysed of which 72 patients (3.5 %) developed PJI. The multivariable analysis showed that Body Mass Index (BMI) >30 (OR2.84, P = 0.020), operating time of <45 min (OR=2.80, P = 0.002), occurrence of haematoma (OR=6.24, P<0.001), decreasing level of hemoglobin (OR=1.62, P = 0.001) and re-operation for luxation (OR=9.25, P<0.001) were significant independent prognostic risk factors for development of PJI after hemiarthroplasty. Diabetes Mellitus (OR=0.34, P = 0.018) and >20 hemiarthroplasties performed by the surgeon in the previous year (OR=0.33, P = 0.019) were prognostic protective factors. In patients with PJI, 40 % (n = 29) died within one year after surgery, compared with 27 % (n = 538) in patients without PJI (OR=1.80, P = 0.017). CONCLUSION Independent significant prognostic factors highly associated with PJI after hemiarthroplasty were BMI >30, operating time of <45, decreasing level of hemoglobin, occurrence of haematoma and re-operation for luxation. Diabetes Mellitus and >20 hemiarthroplasties performed by the surgeon in the previous year were prognostic protective factors for the development of PJI. PJI was associated with significantly higher 1-year all-cause mortality.
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Affiliation(s)
- Eveline de Haan
- Surgery Department, Maasstad Hospital, 3007 AC Rotterdam, the Netherlands; Surgery Department, Franciscus Gasthuis en Vlietland, 3045 PM Rotterdam, the Netherlands.
| | - Gert R Roukema
- Surgery Department, Maasstad Hospital, 3007 AC Rotterdam, the Netherlands
| | | | - T Martijn Kuijper
- Maasstad Academy, Maasstad Hospital, 3079 DZ Rotterdam, the Netherlands
| | - Louis de Jong
- Surgery Department, Maasstad Hospital, 3007 AC Rotterdam, the Netherlands
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Gupta A, Shin J, Oliver D, Vives M, Lin S. Incidence and risk factors for surgical site infection (SSI) after primary hip hemiarthroplasty: an analysis of the ACS-NSQIP hip fracture procedure targeted database. ARTHROPLASTY (LONDON, ENGLAND) 2023; 5:1. [PMID: 36593517 PMCID: PMC9808930 DOI: 10.1186/s42836-022-00155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/16/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Primary hip hemiarthroplasty (HHA) is frequently utilized to treat geriatric hip fractures, which are associated with significantly higher morbidity and mortality. While not particularly common, surgical site infection (SSI) is a major complication that frequently requires revision surgery in a frail population. The objective of this study was to determine the incidence of and risk factors for SSI after HHA in hip fracture patients. MATERIALS AND METHODS This retrospective cohort study was performed using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Geriatric patients (65+) who underwent HHA for non-pathologic, traumatic hip fractures between 2016-2017 were included. Demographic variables, comorbidities, operative variables, and complications were compared between "SSI" and "non-SSI" groups. Multivariate regression identified independent risk factors for postoperative SSI. Significance was set at P = 0.05. RESULTS A total of 6169 patients were included. The overall incidence of SSI was 1.3%. SSI was significantly associated with body mass index (BMI), preoperative functional status, congestive heart failure, chronic corticosteroid use, intraoperative time, sepsis, wound dehiscence, readmission within 30-days, and reoperation. On multivariate analysis, chronic steroid use (OR: 2.30, 95% CI: 1.13-4.70), BMI ≥ 35 kg/m2 (OR: 3.59, 95% CI: 1.57-8.18), and intraoperative time ≥120 mins (OR: 2.15, 95% CI: 1.08-4.27) were found to be independent risk factors. CONCLUSIONS Postoperative SSI is a serious complication that is responsible for prolonged hospital stays, increased mortality, and greater healthcare costs. Here, we identified multiple risk factors for SSI after primary HHA in the US elderly population.
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Affiliation(s)
- Arjun Gupta
- grid.430387.b0000 0004 1936 8796Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Suite D-1610, Newark, NJ 07103 USA
| | - John Shin
- grid.430387.b0000 0004 1936 8796Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Suite D-1610, Newark, NJ 07103 USA
| | - Dylan Oliver
- grid.430387.b0000 0004 1936 8796Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Suite D-1610, Newark, NJ 07103 USA
| | - Michael Vives
- grid.430387.b0000 0004 1936 8796Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Suite D-1610, Newark, NJ 07103 USA
| | - Sheldon Lin
- grid.430387.b0000 0004 1936 8796Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Suite D-1610, Newark, NJ 07103 USA
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Du P, Guo J, Zhu Y, Cui Y, Li J, Feng Z, Hou Z, Zhang Y. Incidence and risk factors associated with postoperative surgical site infection in younger adults with hip fractures: a case-control study. INTERNATIONAL ORTHOPAEDICS 2022; 46:2953-2962. [PMID: 36222882 DOI: 10.1007/s00264-022-05607-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/05/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Hip fracture is associated with high morbidity and mortality. The most common complication after hip fracture is surgical site infection (SSI). The goal was to investigate risks associated with SSI in young adults who underwent surgery for hip fractures. METHODS We conducted a case-control study enrolling 1243 patients from Jan 2015 to Dec 2019. This study investigated the multifaceted factors including demographics, lifestyles, comorbidities, surgical variables, and laboratory test results. Patients were divided into the case group (developed SSI) and control group (not developed SSI). Univariate analyses and multivariate logistic regression analyses were used to identify the risk factors independently associated with SSI. RESULTS A total of 25 patients including 16 (1.8%) in femoral neck fracture and nine (2.5%) in intertrochanteric fracture developed SSI post-operatively, with an accumulated incidence rate of 2.0%. Among them, four cases (1.6%) were deep SSI and 21 cases (98.4%) were superficial SSI. In most cases, Staphylococcus aureus caused the infections. Diabetes mellitus (OR 4.05, 95%CI: 1.08-15.23, P = 0.038), cerebrovascular disease (OR 3.71, 95%CI: 1.14-12.03, P = 0.029), heart disease (OR 6.23, 95%CI: 1.81-21.48, P = 0.004), and operative time (OR 1.01, 95%CI: 1.01-1.02, P = 0.002) in femoral neck fractures while ALP (> upper limit) (OR 33.39, 95%CI: 2.21-504.89, P = 0.011) and CK (> upper limit) (OR 40.97, 95%CI: 1.70-989.31, P = 0.022) in intertrochanteric fractures were found to be significantly associated with SSI. CONCLUSION Targeted pre-operative management, depending on the patients' fracture type and risk factors, should be developed to reduce post-operative SSI rates of younger adults with hip fracture.
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Affiliation(s)
- Pei Du
- Department of Infection Control and Prevention, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Department of Epidemiology and Statistics, Hebei Key Laboratory of Environment and Human Health, School of Public Health, Hebei Medical University, Shijiazhuang, China
| | - Junfei Guo
- Department of Orthopaedics Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
- Orthopaedic Institute of Hebei Province, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Yanbin Zhu
- Department of Orthopaedics Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
- Orthopaedic Institute of Hebei Province, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Yi Cui
- Department of Infection Control and Prevention, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jianmei Li
- Department of Infection Control and Prevention, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhongjun Feng
- Department of Infection Control and Prevention, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiyong Hou
- Department of Orthopaedics Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
- Orthopaedic Institute of Hebei Province, Shijiazhuang, China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, China.
| | - Yingze Zhang
- Department of Orthopaedics Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
- Orthopaedic Institute of Hebei Province, Shijiazhuang, China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, China.
- Chinese Academy of Engineering, Beijing, China.
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Bureau A, Bourget-Murray J, Azad MA, Abdelbary H, Grammatopoulos G, Garceau SP. Management of Periprosthetic Joint Infections After Hemiarthroplasty of the Hip: A Critical Analysis Review. JBJS Rev 2022; 10:01874474-202209000-00006. [PMID: 36155552 DOI: 10.2106/jbjs.rvw.22.00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
➢ Periprosthetic joint infection (PJI) following hip hemiarthroplasty (HA) is a devastating complication, incurring immense health-care costs associated with its treatment and placing considerable burden on patients and their families. These patients often require multiple surgical procedures, extended hospitalization, and prolonged antimicrobial therapy. ➢ Notable risk factors include older age, higher American Society of Anesthesiologists (ASA) score, inadequate antibiotic prophylaxis, non-antibiotic-loaded cementation of the femoral implant, longer duration of the surgical procedure, and postoperative drainage and hematoma. ➢ Although the most frequent infecting organisms are gram-positive cocci such as Staphylococcus aureus, there is a higher proportion of patients with gram-negative and polymicrobial infections after hip HA compared with patients who underwent total hip arthroplasty. ➢ Several surgical strategies exist. Regardless of the preferred surgical treatment, successful management of these infections requires a comprehensive surgical debridement focused on eradicating the biofilm followed by appropriate antibiotic therapy. ➢ A multidisciplinary approach led by surgeons familiar with PJI treatment and infectious disease specialists is recommended for all cases of PJI after hip HA to increase the likelihood of treatment success.
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Affiliation(s)
- Antoine Bureau
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Marisa A Azad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hesham Abdelbary
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Simon P Garceau
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Marusic V, Markovic-Denic L, Djuric O, Cirkovic A, Nikolic V, Dubljanin-Raspopovic E, Kadija M. Incidence and Risk Factors of 30-Day Surgical Site Infection after Primary Total Joint Arthroplasty in a Middle-Income Country: A Single-Center Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030863. [PMID: 33498378 PMCID: PMC7864032 DOI: 10.3390/ijerph18030863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/09/2021] [Accepted: 01/13/2021] [Indexed: 01/08/2023]
Abstract
The data about the incidence and risk factors for surgical site infections (SSIs) following total joint arthroplasty (TJA) in middle-income countries are still scant. The aim of this study was to assess the incidence and risk factors associated with 30-day SSIs following total hip arthroplasty (THA) and total knee arthroplasty (TKA). The study was conducted at the Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Serbia (CCS) in Belgrade, from May 2016 to April 2018. All patients undergoing THA or TKA were followed throughout hospitalization until day 30 after discharge. Of the 1073 admitted patients, 459 had THA and 230 had TKA. The incidence rate of surgical site infections (SSIs) among the patients who underwent THA was 5.4%, which is 3.8 per 1000 postoperative patient-days, while the rate among those who had TKA was 4.8%, i.e., 3.4 per 1000 postoperative patient-days. Out of the 36 SSIs, 15 were deep and 21 were superficial incisional ones. Among the variables examined, the independent risk factors for SSIs after THA were the American Society of Anesthesiologists (ASA) score > 2 (RR = 3.17; 95% CI-1.26-8.02), smoking (RR = 3.14; 95% CI-1.26-7.82) and peripheral vascular disease (PVD) (RR = 6.09; 95% CI-2.35-15.77), and after TKA, only PVD (RR = 3.87; 95% CI-1.09-13.76) was the risk factor. Incidence rates of SSIs after arthroplasty are higher compared to reports from developed countries. Therefore, it is necessary to enhance infection prevention and control measures with strict control of modifiable risk factors.
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Affiliation(s)
- Vuk Marusic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (L.M.-D.); (V.N.)
- Correspondence:
| | - Ljiljana Markovic-Denic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (L.M.-D.); (V.N.)
| | - Olivera Djuric
- Section of Public Health, Center for Environmental, Department of Biomedical, Metabolic and Neural Sciences, Nutritional and Genetic Epidemiology (CREAGEN), University of Modena and Reggio Emilia, 41121 Modena, Italy;
- Epidemiology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Andja Cirkovic
- Institute of Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Vladimir Nikolic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (L.M.-D.); (V.N.)
| | - Emilija Dubljanin-Raspopovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (E.D.-R.); (M.K.)
- Clinic for Physical Medicine and Rehabilitation, Clinical Center Serbia, 11000 Belgrade, Serbia
| | - Marko Kadija
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (E.D.-R.); (M.K.)
- Institute for Orthopedic Surgery and Traumatology, Clinical Centre of Serbia, 11000 Belgrade, Serbia
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Zhao K, Zhang J, Li J, Meng H, Wang Z, Zhu Y, Hou Z, Zhang Y. Incidence and risk factors of surgical site infection after intertrochanteric fracture surgery: A prospective cohort study. Int Wound J 2020; 17:1871-1880. [PMID: 32840067 DOI: 10.1111/iwj.13477] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 12/26/2022] Open
Abstract
Surgical site infection (SSI) is a challenging complication after intertrochanteric fracture surgery but without a large-sample size study to investigate the incidence and risk factors of it. The present study was to investigate the incidence and risk factors of SSI after intertrochanteric fracture surgery. A total of 1941 patients underwent intertrochanteric fracture surgery between October 2014 and December 2018 were included. Demographic data, surgical variables, and preoperative laboratory indexes were obtained from a prospective database and reviewed by hospital records. The optimum cut-off value for quantitative data was detected by receiver operating characteristic analysis. The univariate analysis and multivariable analysis were conducted to analyse the risk factors. In total, 25 patients (1.3%) developed SSI, including 22(1.1%) superficial infection and 3(0.2%) deep infection. After adjustment of multiple variables, gender (odds ratio[OR] 2.64, P = .024), time to surgery>4 days (OR 2.41, P = .046), implant (intramedullary or extramedullary devices) (OR 2.96, P = .036), ALB<35 g/L (OR 2.88, P = .031) remained significant factors. In conclusion, the incidence of SSI after intertrochanteric fractures surgery was 1.3%, with 1.1% for superficial and 0.2% for deep infection. Gender, time to surgery>4 days, the implant (intramedullary or extramedullary devices), and ALB<35 g/L were independent risk factors for the rate of SSI.
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Affiliation(s)
- Kuo Zhao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Junzhe Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Junyong Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hongyu Meng
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhongzheng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
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Liu X, Dong Z, Li J, Feng Y, Cao G, Song X, Yang J. Factors affecting the incidence of surgical site infection after geriatric hip fracture surgery: a retrospective multicenter study. J Orthop Surg Res 2019; 14:382. [PMID: 31752900 PMCID: PMC6873468 DOI: 10.1186/s13018-019-1449-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/31/2019] [Indexed: 12/26/2022] Open
Abstract
Background Geriatric hip fracture is a common type of osteoporotic fracture with high mortality and disability; surgical site infection (SSI) can be a devastating complication of this injury. By far, only a few studies identified easily remediable factors to reduce infection rates following hip fracture and less researches have focused on geriatric patients. The objective of this study was to identify potentially modifiable factors associated with SSI following geriatric hip fracture surgery. Methods This retrospective, multicenter study involves three level I hospitals. A total of 1240 patients (60 years or older) underwent hip surgery with complete data were recruited between January 2016 and June 2018. Demographics information, medications and additional comorbidities, operation-related variables, and laboratory indexes were extracted and analyzed. Receiver operating characteristic (ROC) analysis was performed to detect the optimum cut-off value for quantitative data. Univariate and multivariate logistic analysis model were performed respectively to identify the independent predictors. Results Ninety-four (7.58%) patients developed SSI in this study, and 76 (6.13%) had superficial infection, while 18 (1.45%) were diagnosed with deep infection. Results of univariate and multivariate analysis showed age > 79 years (OR, 2.60; p < 0.001), BMI > 26.6 kg/m2 (OR, 2.97; p < 0.001), operating time > 107 min (OR, 2.18; p = 0.001), and ALB < 41.6 g/L (OR, 2.01; p = 0.005) were associated with an increased incidence of SSI; drainage use (OR, 0.57; p = 0.007) could reduce the incidence of wound infection for patients after geriatric hip fracture. Conclusion Accurate modifiable variables, operating time > 107 min, serum albumin < 41.6 g/L, BMI > 26.6 kg/m2, and age > 79 years could be applied to distinguish geriatric patients with high-risk of postoperative surgical site infection.
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Affiliation(s)
- Xiaopo Liu
- Third Department of Orthopaedics, Tangshan Gongren Hospital, Tangshan, Hebei, 063000, People's Republic of China.
| | - Zhijie Dong
- Department of Orthopaedic Surgery, Hebei General Hospital, Shijiazhuang, Hebei, 063000, People's Republic of China
| | - Jun Li
- Second Department of Orthopaedic Surgery, First Hospital of Hebei Medical University, Shijiazhuang, Hebei, 063000, People's Republic of China
| | - Yunbo Feng
- Third Department of Orthopaedics, Tangshan Gongren Hospital, Tangshan, Hebei, 063000, People's Republic of China
| | - Guolong Cao
- Third Department of Orthopaedics, Tangshan Gongren Hospital, Tangshan, Hebei, 063000, People's Republic of China
| | - Xin Song
- Department of Radiology, Tangshan Gongren Hospital, Tangshan, Hebei, 063000, People's Republic of China
| | - Jie Yang
- First Department of Geriatric, Tangshan Gongren Hospital, Tangshan, Hebei, 063000, People's Republic of China
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Mok WQ, Ullal MJ, Su S, Yiap PL, Yu LH, Lim SMM, Ker SYJ, Wang J. An integrative care bundle to prevent surgical site infections among surgical hip patients: A retrospective cohort study. Am J Infect Control 2019; 47:540-544. [PMID: 30554880 DOI: 10.1016/j.ajic.2018.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/14/2018] [Accepted: 10/15/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) following hip fracture surgeries have profound clinical and economic implications. The study aims to analyze the effect of an integrative SSI prevention care bundle on the SSI incidence among surgical hip patients. The study also aims to examine the association between SSI and mortality, readmission, duration of hospitalization, and hospital cost. METHODS A retrospective cohort study was carried out to assess the incidence of SSI in an acute hip unit in Singapore from January 2015 to September 2017. Patients who developed SSI fell into the exposure group, whereas patients without SSI fell into the nonexposure group. A comparison of the incidence of mortality, readmission, length of stay, and inpatient bill size was conducted between the 2 groups. RESULTS Among 758 hip surgeries performed during the study period, 14 (1.8%) SSIs were documented. Compared with patients with no SSI, patients with SSI were 4.27times more likely to be readmitted within 30days, had 2.47times longer length of stay, and 2.15times the inpatient bill size. CONCLUSIONS An integrative care bundle that capitalizes on the expertise of a multidisciplinary team has promoted shared responsibility and proven to be effective in preventing SSIs while contributing to better patient outcomes within the unit.
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Batibay SG, Soylemez S, Türkmen İ, Bayram Y, Camur S. The effectiveness of preoperative colon cleansing on post-operative surgical site infection after hip hemiarthroplasty. Eur J Trauma Emerg Surg 2019; 46:1071-1076. [PMID: 30949742 DOI: 10.1007/s00068-019-01125-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/29/2019] [Indexed: 11/26/2022]
Abstract
AIM This study aimed to evaluate the effectiveness of prophylactic mechanical bowel preparation in elderly patients undergoing hip hemiarthroplasty in a single training institution over a period of 2 years. PATIENTS AND METHODS The study was conducted in a prospective-randomised manner. All patients, who underwent primary hip hemiarthroplasty for femoral neck fracture in our institution between 20 February 2015 and 29 December 2016, were included. B.T. Enema (sodium dihydrogen phosphate + disodium hydrogen phosphate) 135 ml (Yenisehir Laboratory, Ankara, Turkey) was used for colon cleansing. RESULTS Ninety-five patients were followed up for at least 1 year after surgery (16.3 ± 4.2 months). Of these, 46 were in the enema group and 49 were in the control group. Demographic and clinical characteristics of patients were similar in both groups (p > 0.05). Infection rates between the two groups were not significantly different (p > 0.05). In addition, ASA, age, sex, presence of diabetes mellitus, duration of surgery, time to surgery, ambulation status and blood count did not have a significant effect on surgical site infections (p > 0.05). However, all infections in the enema group were monobacterial and were successfully treated, whereas two of the four infections in the control group were polymicrobial and could not be successfully treated. CONCLUSION Although preoperative colon cleansing did not reduce the overall incidence of post-operative infections, our study suggested that it may reduce polymicrobial infections after hip hemiarthroplasty. Polymicrobial infections after hip hemiarthroplasty seem to have worse prognosis. Therefore, the effectiveness of preoperative colon cleansing in remediating such infections must be investigated in a larger number of patients.
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Affiliation(s)
- Sefa Giray Batibay
- Derince Education and Research Hospital, Department of Orthopedics and Trauma, SB University, Kocaeli, Turkey.
- , Kosuyolu/Istanbul, Turkey.
| | - Salih Soylemez
- Istanbul Fatih Sultan Mehmet Education and Research Hospital, Department of Orthopaedics and Trauma, SB University, Istanbul, Turkey
| | - İsmail Türkmen
- Umraniye Education and Research Hospital, Department of Orthopedics and Trauma, SB University, Istanbul, Turkey
| | - Yusuf Bayram
- Umraniye Education and Research Hospital, Department of Orthopedics and Trauma, SB University, Istanbul, Turkey
| | - Savas Camur
- Umraniye Education and Research Hospital, Department of Orthopedics and Trauma, SB University, Istanbul, Turkey
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Hip Fracture Does Not Belong in the Elective Arthroplasty Bundle: Presentation, Outcomes, and Service Utilization Differ in Fracture Arthroplasty Care. J Arthroplasty 2018; 33:S56-S60. [PMID: 29622493 DOI: 10.1016/j.arth.2018.02.091] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/15/2018] [Accepted: 02/26/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Center for Medicare and Medicaid Services reimbursement is the same for hip arthroplasty performed electively for arthritis and urgently for femoral neck fracture. METHODS An analytic report of hip arthroplasty for a 5-hospital network identified 2362 cases performed from January 2014 to May 2016. Resource utilization was determined using 90-day charges. RESULTS The fracture population (623 hips) was older (P < .01), had more medical comorbidities (28.3% vs 3.8%, P < .01), and was more likely to be anemic and malnourished (P < .01), and had longer hospital stay (5.7 vs 3.0 days, P < .0001), more frequent intensive care unit admission (4.5% vs 0.5%, P < .01), less frequent discharge to home (16.2% vs 83.6%, P < .01), more emergency department visits (26.5% vs 10.7%, P < .01), and more readmissions after hospital discharge (25.2% vs 12.2%, P < .01). Utilization of services ($50,875 vs $38,705, P < .0001) and the standard deviation of these services ($22,509 vs $9,847, P < .0001), from 90-day charges, were significantly greater in the fracture population. CONCLUSION This study supports exclusion of fracture care from the Comprehensive Care for Joint Replacement bundled payment program.
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12
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Risk factors for early infection following hemiarthroplasty in elderly patients with a femoral neck fracture. Eur J Trauma Emerg Surg 2018; 45:207-212. [DOI: 10.1007/s00068-018-0909-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/12/2018] [Indexed: 12/26/2022]
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13
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de Jong L, Klem TMAL, Kuijper TM, Roukema GR. Factors affecting the rate of surgical site infection in patients after hemiarthroplasty of the hip following a fracture of the neck of the femur. Bone Joint J 2017; 99-B:1088-1094. [PMID: 28768787 DOI: 10.1302/0301-620x.99b8.bjj-2016-1119.r1] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/22/2017] [Indexed: 02/06/2023]
Abstract
AIMS Surgical site infection can be a devastating complication of hemiarthroplasty of the hip, when performed in elderly patients with a displaced fracture of the femoral neck. It results in a prolonged stay in hospital, a poor outcome and increased costs. Many studies have identified risk and prognostic factors for deep infection. However, most have combined the rates of infection following total hip arthroplasty and internal fixation as well as hemiarthroplasty, despite the fact that they are different entities. The aim of this study was to clarify the risk and prognostic factors causing deep infection after hemiarthroplasty alone. PATIENTS AND METHODS Data were extracted from a prospective hip fracture database and completed by retrospective review of the hospital records. A total of 916 patients undergoing a hemiarthroplasty in two level II trauma teaching hospitals between 01 January 2011 and 01 May 2016 were included. We analysed the potential peri-operative risk factors with univariable and multivariable logistic regression analysis. RESULTS A total of 92 patients (10%) had a surgical site infection, and 44 (4.9%) developed a deep infection. After univariable analyses, the multivariable model showed that the level of experience of the surgeon measured by the number of hemiarthroplasties performed per year was a significant prognostic factor (odds ratio (OR) 0.93, p = 0.042) for the development of an infection. Secondly, the development of a haematoma (OR 9.6, p < 0.001), a re-operation (OR 4.7, p = 0.004) and an operating time of < 45 mins (OR 5.1, p = 0.002) or > 90 mins (OR 2.7, p = 0.034) were also significant factors. CONCLUSION There was a significant association between the experience of the surgeon and the rate of deep infection. Secondly, a haematoma, a re-operation and both shorter and longer operating times were associated with an increased risk of deep infection after hemiarthroplasty. No association was found between deep infection and the anatomical approach, the time when surgery was undertaken and the use of a drain. Cite this article: Bone Joint J 2017;99-B:1088-94.
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Affiliation(s)
- L de Jong
- Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands
| | - T M A L Klem
- Franciscus Hospital, Kleiweg 500, 3045 PM Rotterdam, The Netherlands
| | - T M Kuijper
- Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands
| | - G R Roukema
- Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands
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Increased infection risk after hip hemiarthroplasty in institutionalized patients with proximal femur fracture. Injury 2016; 47:872-6. [PMID: 26857632 DOI: 10.1016/j.injury.2015.12.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 12/30/2015] [Indexed: 02/06/2023]
Abstract
In patients undergoing hip hemiarthroplasty (HHA) secondary to proximal femur fracture, acute periprosthetic joint infection (PJI) is one of the most important complications. We have detected an increased risk of PJI in chronic institutionalized patients (CIPs), and a higher number of early postoperative infections are caused by Gram-negative bacteria (GNB), not covered by the current prophylaxis (cefazolin in noninstitutionalized patients (NIPs) and cotrimoxazole in CIPs). We sought to compare infection characteristics between NIPs and CIPs, analyzing predisposing factors, causative pathogens, and antibiotic prophylaxis-related microbiological characteristics. We performed a retrospective review of our prospective institutional database to identify all patients consecutively admitted for HHA to treat proximal femur fracture at our centre between 2011 and 2013. PJI was diagnosed in 21 of 381 (5.51%) patients, with 10 of 105 (9.52%) in the CIP group and 11 of 276 (3.99%) in the NIP group, and statistical significance was achieved. GNB accounted for PJI in 14 (66.67%) patients. We detected a single case of methicillin-resistant Staphylococcus aureus (MRSA) infection in the NIP group. We confirm a higher risk of acute PJI among institutionalized patients, commonly caused by Gram-negative microorganisms, which are not covered by the current prophylaxis. New prophylactic strategies should be investigated in order to reduce this problem.
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What are the risk factors for post-operative infection after hip hemiarthroplasty? Systematic review of literature. INTERNATIONAL ORTHOPAEDICS 2015; 40:1843-8. [DOI: 10.1007/s00264-015-3033-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/01/2015] [Indexed: 12/21/2022]
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