A Multicentric Analysis of Risk Factors for Surgical Site Infection after Hip Arthroplasty

The goal of this study is to address three key questions: What is the risk of wound infection for hip arthroplasty patients? What are the major etiologic agents for infection of the surgical site (SSI)? What risk factors are more associated with infection at the surgical site? Method: This is a multicentric, retrospective cohort study that examined data collected between January 2009 and December 2013 in five general hospitals in a major city in Brazil. Age, length of hospital stay before surgery, period of surgery, number of surgery practitioners and number of hospital admissions were the ongoing parameters examined. Surgical wound classification (clean, clean-contaminated, contaminated, dirty / infected), American Society of Anesthesiologists (ASA) score (I, II , III , IV, V), form of procedure (elective, emergency), general anaesthesia (yes, no), prophylactic antibiotics (yes, no), danger index for trauma surgery (yes, no) and Nosocomial Infections Surveillance (NNIS) (IRIC = 0 , 1, 2, 3) were categorical variables. Results: The approximate SSI risk was 3.2% (95% C.I. = 2.6% to 4.1%) and the risk of osteomyelitis was 0.6% (95% C.I. = 0.4% to 1.1%). The risk factors for SSI after hip prosthesis were ASA score > 2, general anaesthesia, hospital stay prior to surgery longer than four days, more than two surgical professionals and surgery period greater than five hours (p < 0.05). The final multiple logistic regression analysis showed that the changed NNIS risk after hip arthroplasty was independently correlated with surgical site infection. Conclusion: Despite the risk factor for SSI being the updated NNIS index, none of its independent variables were statistically significant (p>0.100) in the logistic model. As compared to the previous category, each changed NNIS risk category increases the likelihood of a patient being infected almost three times (OR = 2.82; p=0.011). Our study found out that the use of general anaesthesia and the number of surgical practitioners greater than 2 are risk factors for the development of SSI after THA with an ASA score higher than 2. Only the Updated NNIS risk index was referred to as a risk factor for SSI in our multivariate analysis. It is proposed that antibiotic prophylaxis is a preventive measure against SSI. This research has some drawbacks as a retrospective examination. Nevertheless, it indicates significant possibilities for improving the standard of treatment and preventing SSI in hip arthroplasty, such as avoiding general anaesthesia, keeping operational resources to a minimum and reducing operating room traffic. The creation of new pre-surgery procedures or the study and adherence of existing ones, as well as the proper collection of data for future research, may be effective steps to minimise the risk of infection in the hospitals studied.

Author(s) Details

Gabriel B. Tofani
Hospital MaterDei, Belo Horizonte, Brazil.

Gustavo P. Irffi
Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

Gilberto D. Miranda
Universidade de Alfenas – Unifenas. Hospital Universitário Alzira Velano, Alfenas, Brazil.

Bráulio R. G. M. Couto
Centro Universitário de Belo Horizonte – UniBH, Belo Horizonte, Brazil.

Carlos E. F. Starling
Hospitals Life Center, Vera Cruz, and Baleia, Belo Horizonte, Brazil.

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