Abstract
The aim of this study was to determine the incidence, annual trend, and perioperative outcomes and identify risk factors of early-onset ( d) deep surgical site infection (SSI) following primary total hip arthroplasty (THA) for osteoarthritis. We performed a retrospective study using prospectively collected patient-level data from January 2013 to March 2020. The diagnosis of deep SSI was based on the published Centre for Disease Control/National Healthcare Safety Network (CDC/NHSN) definition. The Mann–Kendall trend test was used to detect monotonic trends. Secondary outcomes were 90 d mortality and 90 d readmission. A total of 22 685 patients underwent primary THA for osteoarthritis. A total of 46 patients had a confirmed deep SSI within 90 d of surgery representing a cumulative incidence of 0.2 %. The annual infection rate decreased over the 7-year study period (). Risk analysis was performed on 15 466 patients. Risk factors associated with early-onset deep SSI included a BMI 30 kg m (odds ratio (OR) 3.42 [95 % CI 1.75–7.20]; ), chronic renal disease (OR, 3.52 [95 % CI 1.17–8.59]; ), and cardiac illness (OR, 2.47 [1.30–4.69]; ), as classified by the Canadian Institute for Health Information. Early-onset deep SSI was not associated with 90 d mortality () but was associated with an increased chance of 90 d readmission (). This study establishes a reliable baseline infection rate for early-onset deep SSI after THA for osteoarthritis through the use of a robust methodological process. Several risk factors for early-onset deep SSI are potentially modifiable, and therefore targeted preoperative interventions of patients with these risk factors is encouraged.
Highlights
Total hip arthroplasty (THA) is known to be highly successful at alleviating pain and disability, providing substantial improvement in quality of life (Harris, 2009)
Our study found that the annual rate of early-onset deep surgical site infection (SSI) following primary THA for osteoarthritis decreased between January 2013 and December 2019
This study may have been underpowered to detect the early effects of diabetes that might have been more obvious if we looked at later time points
Summary
Total hip arthroplasty (THA) is known to be highly successful at alleviating pain and disability, providing substantial improvement in quality of life (Harris, 2009). The number of THA procedures has increased over 20 % in the last 5 years (Canadian Institute for Health Information, 2021) and is projected to grow in step with the aging demographics of the population (Singh et al, 2019; Kurtz et al, 2007). Despite improved infection prevention protocols and surgical technique, surgical site infection (SSI) and periprosthetic joint infection (PJI) following THA continue to be a serious problem. These infections result in significant individual morbidity and increase mortality risk (Gundtoft et al, 2017; Moore et al, 2015; Zmistowski et al, 2013). Due to the projected increase in demand for THA, it is highly likely that the absolute number of SSI cases will continue to increase (Kamath et al, 2015; Perfetti et al, 2017; Premkumar et al, 2021)
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