Surgical site infection surveillance for elective primary total hip and knee arthroplasty in Winnipeg, Manitoba, Canada

Abstract

Surgical site infections (SSIs) increase morbidity and mortality after primary hip and knee arthroplasty. We evaluated a surveillance program that tracked risk factors associated with infection after primary hip and knee arthroplasty in the Winnipeg Regional Health Authority. Surveillance data from April 2010 to March 2015 were reviewed for all 12,636 primary hip or knee arthroplasties, including 1-year follow-up. Procedures were evaluated in earlier (April 2010 to December 2012) and later periods (January 2013 to March 2015). Risk factors for postoperative infection were evaluated. There were 154 SSIs in 12,636 operations (1.22%) (earlier, 98 infections in 6,613 operations [1.48%]; later, 56 infections in 6,023 operations [0.93%]). The frequency of primary hip arthroplasty deep infection decreased from earlier to later periods; the frequency of primary knee arthroplasty infection was similar between the time periods. Independent risk factors associated with increased SSI risk included higher body mass index. SSI frequency was inversely associated with maintaining immediate postoperative temperature between 36°C and 38°C and surgery in the later period. Surveillance was effective in decreasing the frequency of deep infection after primary total hip arthroplasties but not after knee arthroplasties. Surveillance of orthopedic surgery with feedback of SSI rates to the front-line staff may result in improvement in surgical outcomes.