Background

The increased demand for hip arthroplasty means a growing number of postsurgical complications. This study aims to assess the risk of surgical site infection (SSI) in a teaching hospital; develop regional, national and international external comparisons; and evaluate SSI-related risk factors, particularly according to the timing of surgery (urgent/unplanned or elective).

Methods

Prospective cohort study from January 2008 to December 2018. Patients were followed up to 90 days after surgery. Primary endpoint was SSI incidence according to the Centers for Disease Control and Prevention criteria. Multivariate analysis was conducted to find independently associated SSI risk factors. The association between risk factors and SSI incidence was assessed by reference to odds ratio (OR). Analyses were also performed among urgent/unplanned and elective patients to identify whether SSI risk factors differed between groups.

Results

The study population (n = 1,808) has an overall SSI rate of 3.0% (95% confidence interval [CI]: 2.4-3.9). Timing of surgery caused an effect modification, so surgery duration> 75th percentile (OR: 3.8; 95% CI: 1.5-9.8) and inadequate preparation (OR: 3.3; 95% CI: 1.1-10.0) were independent risk factors in the urgent/unplanned group; National Healthcare Safety Network risk index≥ 2 (OR: 6.3; 95% CI: 0.1-19.2) and transfusion (OR: 3.6; 95% CI: 1.1-11.9) in the elective group.

Conclusions

Hospital infection surveillance systems allow identifying risk factors susceptible to change. Characterization of factors that caused an effect modification is key to identify areas of quality improvement, including reducing operating times, preventing perioperative blood transfusion, or improving patient preparation before surgery.

中文翻译：

---

一项为期10年的前瞻性研究中髋关节置换术中的手术部位感染：风险和相关因素。

背景

对髋关节置换术的需求增加意味着越来越多的术后并发症。这项研究旨在评估教学医院的手术部位感染（SSI）的风险。进行区域，国家和国际外部比较；并评估与SSI相关的危险因素，尤其是根据手术时机（紧急/计划外或选择性）。

方法

从2008年1月至2018年12月进行的前瞻性队列研究。对患者进行了术后90天的随访。根据疾病控制和预防中心的标准，主要终点是SSI发生率。进行多变量分析以发现独立相关的SSI危险因素。风险因素与SSI发生率之间的关联性通过参考优势比（OR）进行评估。还对紧急/计划外和择期患者进行了分析，以确定两组之间的SSI危险因素是否不同。

结果

研究人群（n = 1,808）的总SSI率为3.0％（95％置信区间[CI]：2.4-3.9）。手术时机导致效果改变，因此手术持续时间> 75％（OR：3.8; 95％CI：1.5-9.8）和准备不足（OR：3.3; 95％CI：1.1-10.0）是紧急情况下的独立危险因素。 /计划外小组；选修组的国家医疗安全网络风险指数≥2（OR：6.3; 95％CI：0.1-19.2）和输血（OR：3.6; 95％CI：1.1-11.9）。

结论

医院感染监测系统可以识别易变的危险因素。引起效果改变的因素的表征是确定质量改善领域的关键，包括缩短手术时间，防止围手术期输血或改善手术前患者的准备。