Risk factors of surgical site infections in hip hemiarthroplasty: a single-institution experience over nine years

Lau, Adrian Cheng Kiang; Neo, Ghim Hoe; Lee, Haw Chou

doi:10.11622/smedj.2014137

Cited by 19 publications

(15 citation statements)

References 13 publications

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“…Lau et al show that the time to surgery >7 days was associated with the rate of SSIs in hip hemiarthroplasty. 26 What resulted in surgical delay were that the sicker and frailer patients always needed medical adjustments to tolerate surgery. These patients were often accompanied with older age and more than one medical complication, explaining a higher risk of SSI.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors of surgical site infection after intertrochanteric fracture surgery: A prospective cohort study

Zhao

Zhang

et al. 2020

International Wound Journal

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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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Section: Discussionmentioning

confidence: 99%

Incidence and risk factors of surgical site infection after intertrochanteric fracture surgery: A prospective cohort study

Zhao

Zhang

et al. 2020

International Wound Journal

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“…Deep wound infection is defined as infection that occurs within 90 days post-operation, and involves the fascial and muscular layer. SSI refers to bone or hip joint diagnosed with organ/space infection, according to the previous study [9].…”

Section: Methodsmentioning

confidence: 99%

“…From an economic perspective, SSI accounts for 17% of nosocomial infections and cost between 1 and 10 billion US dollars annually [6]. Risk factors associated with wound infection which were established in previous studies included body mass index (BMI) [7], smoking [8], urinary tract infection [9], female gender [10], delay in surgery (more than 1 week) [11], prolonged operating time [12], and surgical type (hemiarthroplasty) [12]. However, most of these predictors were unmodifiable, and the findings might be partially compromised by the limited sample size of these studies; moreover, some of these investigations possess the feature of single center.…”

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confidence: 99%

Factors affecting the incidence of surgical site infection after geriatric hip fracture surgery: a retrospective multicenter study

Liu

Dong

et al. 2019

J Orthop Surg Res

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BackgroundGeriatric 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.MethodsThis 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.ResultsNinety-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.ConclusionAccurate 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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“…The incidence of PJI following HHA for hip fracture ranges between 1.6 and 6.0%. [1][2][3][4][5] While there are established criteria for PJI in THA, there are no such criteria for HHA and it remains to be determined whether or not the THA criteria are applicable to HHA. [7][8][9][10][11][12] Overall, the mean ESR value in infected HHAs was 50.3 mm/h, while the mean CRP value was 29.9 mg/L.…”

Section: Discussionmentioning

confidence: 99%

ESR and CRP Diagnostic Thresholds for Prosthetic Joint Infection in Hip Hemiarthroplasty

Warren

Scotting

Anis

et al. 2020

The Journal of Hip Surgery

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Diagnostic thresholds used to standardize the definition for prosthetic joint infection (PJI) have largely focused on total joint arthroplasty (TJA). Established PJI thresholds exist for serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in TJA; however, they do not exist for revision hip hemiarthroplasty (rHHA). The purpose of this study was to establish thresholds for (1) ESR and (2) CRP to diagnose PJI in rHHA. Data were collected on a prospective cohort of 69 rHHA patients undergoing orthopaedic surgery between 1/2017 and 2/2019 in a single health care system. Procedures were categorized as septic or aseptic revisions using Musculoskeletal Infection Society (MSIS) criteria (2013). There were 44 ESRs (n = 28 aseptic, n = 16 septic) and 46 CRPs (n = 29 aseptic, n = 17 septic) available for analysis. Two tailed t-tests were performed to compare the mean ESR and CRP in aseptic and septic cases. Receiver operator characteristic (ROC) curves were generated to obtain diagnostic cutoff thresholds using the Youden's Index (J) for ESR and CRP. The mean ESR was 50.3 ± 30.6 mm/h versus 15.4 ± 17.7 mm/h (p < 0.001), while the mean CRP was 29.9 ± 24.8 mg/L versus 4.1 ± 8.2 mg/L (p < 0.001) for septic and aseptic revisions, respectively. The diagnostic threshold for PJI determined by the ROC curve was 44 mm/h for ESR (sensitivity = 56.3%; specificity = 100.0%; J = 0.563; area under the curve (AUC) = 0.845), while it was 12.5 mg/L for CRP (sensitivity = 70.6%; specificity = 96.6%; J = 0.672; AUC = 0.896). For patients with HHA, an ESR of 44 mm/h was and a CRP of 12.5 mg/L was highly specific for PJI. The thresholds are similar to the MSIS thresholds currently published. Larger prospective trials are needed to establish more robust and conclusive diagnostic criteria for PJI in HHA, including investigations not only of ESR and CRP but synovial white blood cell count and synovial polymorphonuclear leukocytes % as well.

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Risk factors of surgical site infections in hip hemiarthroplasty: a single-institution experience over nine years

Cited by 19 publications

References 13 publications

Incidence and risk factors of surgical site infection after intertrochanteric fracture surgery: A prospective cohort study

Incidence and risk factors of surgical site infection after intertrochanteric fracture surgery: A prospective cohort study

Factors affecting the incidence of surgical site infection after geriatric hip fracture surgery: a retrospective multicenter study

ESR and CRP Diagnostic Thresholds for Prosthetic Joint Infection in Hip Hemiarthroplasty

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