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Title: Post-discharge surveillance of healthcare-associated infections after hip prosthesis and knee prosthesis in 2017 based on the national database of 83252 patients
Abstract:
Introduction Arthroplasty is an increasingly frequently performed surgical procedure in the field of the musculoskeletal system due to its impact on improving the quality of life of patients. Its importance and frequency are increasing in the aging population due to the progressive degeneration of joints and the associated reduced mobility and chronic pain. In infection control and surveillance, arthroplasty procedures classified as primarily "clean" are used to assess the incidence of surgical site infections and are subject to targeted surveillance. Among other healthcare-associated infections (HAIs), pneumonia dominates and is particularly common in the geriatric population. However, data from Poland lack detailed data on infections in patients after hip arthroplasty (HPRO) or knee arthroplasty (KPRO). So far, no multicenter analysis of post-discharge surgical site infections after arthroplasty procedures has been performed in Poland. There have also been no studies considering a large patient population. For this reason, the aim of the study was to assess post-discharge infections in patients after hip or knee arthroplasty. Materials and methods The study used retrospective data from the National Health Fund (NFZ) and related registers for 2017 prepared and initially anonymised by the Division of Databases and Analytical Tools of the Department of Analysis ; and Innovation of the Headquarters of the National Health Fund in Warsaw. A preliminary analysis of a database of 83,252 hip and knee surgeries showed that the most common forms of infection were pneumonia (PNU) and surgical site infections (SSI). Cases of surgical site infection were identified using the code T84.5 (ICD-10) in databases maintained by hospitals, primary care clinics, specialist clinics and hospital emergency departments or emergency rooms up to 90 days after surgery as defined by ECDC. Pneumonia cases were identified using codes J13.*, J15.*, J16.*, and J18.8 (ICD-10) in primary and specialty outpatient databases or during readmission. The statistical analysis used relative and absolute frequencies for nominal variables and the mean value with standard deviation for quantitative variables. To compare groups of patients, the chi-square test or Fisher's exact test for variables with a very small number of observations and the Student's t-test were used. The risk of infection was assessed in a multivariate logistic regression model. Multivariate models mainly included variables reaching significance in univariate analysis. Significance level was assessed as p<0.05. Results The cumulative incidence of SSI after hospital discharge was 0.92% for HPRO and 0.95% for KPRO. The main risk factors for hip SSI were male gender, diseases of the hematopoietic ; , musculoskeletal and nervous systems. The greater risk factor for knee SSI was the male gender. All comorbidities significantly increased the risk of SSI. Staying in the ICU and administered antibiotics at discharge in the study population increased the risk of detecting SSI after HPRO and KPRO up to 4 and 7 times, respectively. For both procedures, postoperative rehabilitation and total endoprosthesis reduced the incidence of SSI. Lower experience of the center was associated with a higher incidence of SSI in HPRO in primary surgeries (1.5% vs. 0.9%) and in revision surgeries (3.8% vs. 2.1%), while in KPRO lower experience only in primary surgery was significantly associated with SSI. Post-discharge pneumonia was diagnosed in 371 patients and accounted for 26.6% of all post-discharge infections, with an incidence of 0.7%. Multivariate analysis showed a significantly higher risk of pneumonia in patients aged 65 years and older (odds ratio [OR] 3.5; 95% CI 2.40–5.03) and hospitalized urgently (OR 4.0; 95% CI 3.16–4.98), operated on in winter (OR 1.7; 95% CI 1.37–2.11) and hospitalized in the intensive care unit (OR 5.9; 95% CI 3.65–9, 46). Preventive factors included preoperative treatment of musculoskeletal diseases (OR 0.7; 95% CI 0.59–0.91) and postoperative rehabilitation (both outpatient and inpatient; OR 0.3; 95% CI 0.10– 0.99 and OR 0.7; 95% CI 0.42–0.99, ; respectively). Seventy patients (18.9% of pneumonia cases) required hospital treatment for pneumonia. The reported in-hospital mortality rate for pneumonia after discharge was 21.4%. Conclusions The presented results indicate a higher-than-expected incidence of both SSI and PNU in post-discharge follow-up. This requires the introduction of appropriate preventive measures, such as preoperative and postoperative rehabilitation, a thorough geriatric assessment, and the recommendation of vaccinations. Increased outpatient supervision appears justified in the group of patients hospitalised longer than standard, discharged with antibiotics, and hospitalised in the ICU. These activities can contribute to a reduction in patient mortality, which, as shown for PNU, can exceed 20% among rehospitalised patients.
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Rada Dyscypliny Nauki medyczne
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Last modified:
Oct 8, 2024
In our library since:
Oct 8, 2024
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http://dl.cm-uj.krakow.pl:8080/publication/5160
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| Edition name | Date |
|---|---|
| ZB-140538 | Oct 8, 2024 |
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