infection control & hospital epidemiology october 2015, vol. 36, no. 10 original article
Surgical Site Infection After Primary Hip and Knee Arthroplasty: A Cohort Study Using a Hospital Database
Leslie Grammatico-Guillon,MD, PhD;1 Sabine Baron, MD;2 Philippe Rosset, MD, PhD;3 Christophe Gaborit, Statistical Engineer;2 Louis Bernard,MD, PhD;4 Emmanuel Rusch,MD, PhD;1 Pascal Astagneau, MD, PhD5
background. Hip or knee arthroplasty infection (HKAI) leads to heavy medical consequences even if rare.
objective. To assess the routine use of a hospital discharge detection algorithm of prosthetic joint infection as a novel additional tool for surveillance.
methods. A historic 5-year cohort study was built using a hospital database of people undergoing a first hip or knee arthroplasty in 1 French region (2.5 million inhabitants, 39 private and public hospitals): 32,678 patients with arthroplasty code plus corresponding prosthetic material code were tagged. HKAI occurrence was then tracked in the follow-up on the basis of a previously validated algorithm using International Statistical Classification of Disease, Tenth Revision, codes as well as the surgical procedures coded. HKAI density incidence was estimated during the follow-up (up to 4 years after surgery); risk factors were analyzed using Cox regression.
results. A total of 604 HKAI patients were identified: 1-year HKAI incidence was1.31%, and density incidence was 2.2/100 person-years in hip and 2.5/100 person-years in knee. HKAI occurred within the first 30 days after surgery for 30% but more than 1 year after replacement for 29%. Patients aged 75 years or older, male, or having liver diseases, alcohol abuse, or ulcer sore had higher risk of infection. The inpatient case fatality in HKAI patients was 11.4%.
conclusions. The hospital database method used to measure occurrence and risk factors of prosthetic joint infection helped to survey HKAI and could optimize healthcare delivery.
Infect. Control Hosp. Epidemiol. 2015;36(10):1198–1207
Surgical site infections after knee and hip replacement have been a key target recommended by the Centers for Disease Control and Prevention for epidemiological surveillance for the past couple decades.1–7 Rates of surgical site infections after total joint arthroplasty are estimated at 0.5%–6%in the United States8–10 and 0.5%–1.0% in Europe.5,11–13 Prosthetic joint infections (PJI) of the hip or knee are devastating with heavy medical consequences of multiple reoperations, prolonged hospital stay, and functional disability,5,14,15 which result in increasing financial burden and sometimes litigation, with the emotional component emphasized by the media.1–5 Results of 3 decades of surveillance give evidence about the
effectiveness of these systems but highlight failures in terms of postdischarge, long-term follow-up, and completeness of data.6 This statement brings up the necessity to develop a new approach to complete these existing methods. Use of French medico-administrative databases (Programme de Médicalisation
des Systèmes d'Information) could provide a computerized PJI detection, decreasing time for reporting data.5,9,16–19 This study assessed the routine use of a hospital discharge algorithm for PJI detection and surveillance. In addition, risk factors associated with increasing PJI morbidity and mortality rates after a first hip or knee arthroplasty could be determined.
methods Study Design
A historic cohort study was performed using 1 French regional hospital discharge database 2008–2012, corresponding to all hospital stays from residents of this region (Région Centre, 2.5 million inhabitants, 38 private and public hospitals). Patients were selected by the presence in the hospital discharge, from January 1, 2008, throughDecember 31, 2011, of a surgical hip or knee arthroplasty procedure according to the French Common
Affiliations: 1. Service d’Information Médicale, d’Epidémiologie et d’Economie de la Santé, Centre Hospitalier Régional Universitaire de Tours, Laboratoire
de santé publique, Université François Rabelais, Tours, France; 2. Unité régionale d’épidémiologie hospitalière, Centre Hospitalier Régional Universitaire de Tours, France; 3. Service de chirurgie orthopédique, Centre Hospitalier Régional Universitaire Tours, Université François Rabelais, Tours, France; 4. Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Régional Universitaire Tours, Université François Rabelais, Tours, France; 5. Ecole des Hautes Etudes en Santé Publique & Centre de coordination pour la lutte contre les infections associées aux soins, Paris, France.
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2015/3610-0010. DOI: 10.1017/ice.2015.148 Received January 21, 2015; accepted May 25, 2015; electronically published July 8, 2015
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