Infection Control & Hospital Epidemiology


1193


Table 2. Comparison of Projected 2020 to 2030 Primary and Revision Hip and Knee Arthroplasty Surgical Site Infections (SSIs) With and Without an Infection Rate Reduction of 30%


2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030


All Arthroplasties SSIs without rate reduction SSIs with rate reduction


SSIs prevented with rate reduction


Primary and Revision Arthroplasties Hip SSIs without rate reduction Hip SSIs with rate reduction


SSIs prevented with rate reduction Knee SSIs without rate reduction Knee SSIs with rate reduction SSIs prevented with rate reduction


Primary Arthroplasties Hip SSIs without rate reduction Hip SSIs with rate reduction


SSIs prevented with rate reduction Knee SSIs without rate reduction Knee SSIs with rate reduction SSIs prevented with rate reduction


Revision Arthroplasties Hip SSIs without rate reduction Hip SSIs with rate reduction


SSIs prevented with rate reduction Total


6,569 6,671 6,773 6,874 6,972 7,076 7,171 7,262 7,349 7,430 7,506 77,653 4,598 4,670 4,741 4,812 4,881 4,953 5,020 5,083 5,144 5,200 5,254 54,356 1,971


2,001 2,032 2,062 2,091 2,123 2,151 2,179 2,205 2,230 2,252 23,297


3,510 3,567 3,624 3,682 3,738 3,798 3,854 3,909 3,964 4,015 4,063 41,724 2,457 2,497 2,537 2,577 2,617 2,658 2,698 2,736 2,775 2,810 2,844 29,206 1,053


1,070 1,087 1,105 1,121 1,140 1,156 1,173 1,189 1,205 1,219 12,518


3,059 3,104 3,149 3,192 3,234 3,278 3,317 3,353 3,385 3,415 3,443 35,929 2,141 2,173 2,204 2,235 2,264 2,295 2,322 2,347 2,369 2,390 2,410 25,150 918


931 945 957 970 983 995 1,006 1,016 1,025 1,033 10,779


2,674 2,708 2,745 2,782 2,818 2,859 2,898 2,936 2,976 3,011 3,046 31,453 1,872 1,896 1,921 1,947 1,973 2,002 2,029 2,055 2,083 2,108 2,132 22,018 802


812 824 835 845 857 869 881 893 903 914 9,435


2,216 2,238 2,263 2,286 2,309 2,335 2,358 2,379 2,397 2,414 2,430 25,625 1,551 1,567 1,584 1,600 1,616 1,635 1,651 1,665 1,678 1,690 1,701 17,938 665


671


836 585 251


Knee SSIs without rate reduction 843 Knee SSIs with rate reduction SSIs prevented with rate reduction


590 253


859 601 258 865 606 259


679


880 616 264 887 621 266


686


900 630 270 906 635 271


693


920 644 276 925 648 277


700


938 657 281 943 660 283


707


956 669 287 959 671 288


714


973 681 292 974 682 292


719


989 692 297 988 691 297


724 729 7,687


1,003 1,017 10,271 702 301


712 305


708 304


7,189 3,082


1,001 1,012 10,303 700 301


7,212 3,091


Discussion


The results of our study provide overall arthroplasty and SSI burden projections for the years 2020 through 2030, assuming constant rates. We project a 13% increase in arthroplasties and 14% increase in SSIs, with 60%–70% of arthroplasties and SSIs occurring in the 65 and older age group. Our model demonstrates that even with stable arthroplasty and SSI rates, demographic changes in the US population will result in more arthroplasties and SSIs, as well as an increased public health burden. The HHS previously set a target for a 25% reduction from 2009 SSI rates, and only achieved an 18% reduction by 2014.13 In an update to the HAI Action Plan, the HHS defined a new target of a 30% reduction from 2015 SSI rates. This study shows that achieving this goal would prevent 23,000 SSIs, demonstrating the impor- tance of prevention in reducing the health and subsequent eco- nomic impact of SSIs.


Public health impact


Our study predicts burden for attributable SSIs following hip and knee arthroplasties (including only the first arthroplasty revision). While our burden estimates for procedures and infections may represent a subset of other estimates28 because we selected only complex SSIs as defined by NHSN21 following hip and knee arthroplasty, we feel that these infections are more influential because they represent more severe and costly infections occur- ring in common procedures. It is important to understand the burden of this subset of infections because NHSN infection rates are used by the HHS to track progress on eliminating HAIs and to represent areas of measured improvement. When developing HAI interventions, policy makers set health


priorities for prevention. TheCDCrecommends that states identify priority infections when developing their policy interventions.16 Estimates of future burden may help prioritize the development of


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