Patient-related factors associated with superficial surgical site infection and progression to a periprosthetic joint infection after elective primary total joint arthroplasty: a single-centre, retrospective study in Sweden

Abstract

ObjectivesSuperficial surgical site infection (SSSI) may increase the risk of serious complications such as periprosthetic joint infection (PJI). This study aims to identify patient-related risk factors associated with SSSI and investigate their correlation with the progression of PJI.DesignIn this retrospective study, 1191 elective hip and knee prostheses were included. Patients were interviewed 3–5 months after surgery to answer questions about the postoperative period. Patient records were reviewed to determine whether there had been any documentation of wound-healing difficulties or whether antibiotics were prescribed to treat an infection related to arthroplasty surgery.SettingUppsala University Hospital, patients treated between November 2008 and December 2012.ParticipantsThe study population comprised 433 knees and 758 hips.Outcome measuresWe studied patient-related risk factors (joint, age, sex, the American Society of Anesthesiologists (ASA) classification, body mass index (BMI), smoking, diabetes and rheumatic disease) to determine whether they were associated with (1) SSSI and (2) the progress from SSSI to PJI.Results84 (7%) patients of the total cohort developed SSSI. This infection progressed to a PJI in 24 (29%) of the patients. Factors with increased adjusted risk ratios (aRRs) for SSSIs were knee surgery (1.7; 95% CI: 1.1 to 2.7), age≥65 years (1.7; 95% CI: 1.1 to 2.8), BMI≥30 (1.9; 95% CI: 1.0 to 3.4) and ASA classification≥3 (1.7; 95% CI: 1.0 to 2.9). ASA classification≥3 was the only factor showing a significant progression from SSSI to PJI (aRR=3.3; 95% CI: 1.0 to 10.3).ConclusionsThe risk of progressing from an SSSI to a PJI is high. Older patients, patients with obesity, and those with a high ASA classification considered for elective total knee arthroplasty seem to have an increased risk of developing SSSI. Patients with a high ASA classification seem to have an increased risk of progressing from SSSI to PJI.

Prevalence of modifiable risk factors in primary elective arthroplasty and their association with infections

“…Superficial SSI occurred in 8%, which is higher than the 1% to 2.5% reported from the USA (29) but similar to the 7% in Sweden (1). We identified an association with elevated BMI and HbA1c.…”

“…Superficial SSI progressed to PJI in 7 of 57 (12%) cases, which is lower than in a recent report from Sweden where the progression rate was 29%. However, their follow-up time was slightly longer than was used in our study (1).…”

“…Superficial surgical-site infection (SSI) is a feared complication of total joint arthroplasty (TJA), occurring in 1-10% of cases. It may progress into periprosthetic joint infection (PJI), a devastating complication that occurs in between 0.5% and 2.4% of primary hip and knee TJAs (1,2). Several underlying medical conditions have been identified as independent risk factors for development of PJI that might be modified before operation (3).…”

Risk factors for surgical site infection after percutaneous endoscopic lumbar discectomy

“…SSI defined as an infection that occurs at or near the surgical incision site within 30 days of surgery can have serious consequences, including prolonged hospital stays, repeat surgery, prolonged morbidity and even death 13,14 . Previous studies have shown that the occurrence of SSI after orthopaedic‐related surgery is a multifactorial event influenced by a variety of factors 15,16 . Although there is a large body of literature on the subject, it often leads to inconsistent conclusions and a lack of consensus in identifying these risk factors 17,18 .…”

“… 13 , 14 Previous studies have shown that the occurrence of SSI after orthopaedic‐related surgery is a multifactorial event influenced by a variety of factors. 15 , 16 Although there is a large body of literature on the subject, it often leads to inconsistent conclusions and a lack of consensus in identifying these risk factors. 17 , 18 This discrepancy in the literature suggests an urgent need for more comprehensive studies.…”