Risk factors associated with surgical site infection in 30,491 primary total hip replacements

Area of Science:

• Orthopedic Surgery
• Infectious Disease Epidemiology
• Health Services Research

Background:

• Deep surgical site infection (SSI) is a significant complication following total hip replacement (THR).
• Identifying patient and surgical risk factors is crucial for preventing SSI and improving patient outcomes.
• Previous studies have yielded varied results regarding risk factors for THR-associated SSI.

Purpose of the Study:

• To identify patient and surgical factors associated with deep SSI after primary THR.
• To analyze data from a large integrated healthcare system to determine risk factors for SSI.
• To inform strategies for SSI prevention in THR patients.

Main Methods:

• Retrospective review of a cohort of 30,491 primary THRs performed between 2001 and 2009.
• Utilized the Kaiser Permanente Total Joint Replacement Registry (TJRR) for patient and surgical data.
• Employed proportional-hazard regression models to assess SSI risk factors.

Main Results:

• The overall incidence of deep SSI was 0.51% (155 cases).
• Patient factors associated with increased SSI risk included female gender, obesity, and American Society of Anesthesiologists (ASA) score ≥ 3.
• Bilateral THR procedures were identified as the only surgical factor significantly associated with increased SSI risk.

Conclusions:

• Obesity and pre-existing chronic medical conditions should be managed before THR surgery.
• Female gender and higher ASA scores are patient-related risk factors for SSI after THR.
• The increased SSI risk observed with bilateral THR procedures requires further investigation and may influence surgical planning.