Temporal Trends in Deep Surgical Site Infections After Six Orthopaedic Procedures Over a 12-year Period Within a...

Area of Science:

• Orthopaedic Surgery
• Infectious Disease Epidemiology
• Healthcare Quality Improvement

Background:

• Perioperative optimization and SSI prevention strategies are key in centers of excellence.
• Decolonization protocols and antibiotic prophylaxis aim to reduce surgical site infections.

Purpose of the Study:

• To evaluate time trends in deep surgical site infection (SSI) incidence.
• To identify causative organisms of deep SSI after six common orthopaedic procedures.

Main Methods:

• Population-level time-trend study (2009-2020) using orthopaedic registry data.
• Included anterior cruciate ligament reconstruction, total knee arthroplasty, elective total hip arthroplasty, hip fracture repair, shoulder arthroplasty, and spine surgery.
• Assessed 90-day deep SSI incidence using CDC/NHSN guidelines with manual chart validation; Poisson regression analyzed trends.

Main Results:

• A total of 465,797 procedures were analyzed.
• Decreasing deep SSI trends observed for anterior cruciate ligament reconstruction and hip fracture repair.
• No consistent decreasing trends for total knee arthroplasty, elective total hip arthroplasty, shoulder arthroplasty, or spine surgery; increasing polymicrobial infections noted after TKA and Cutibacterium acnes after THA.

Conclusions:

• Deep SSI incidence is rare across six orthopaedic procedures.
• Declining SSI rates were confirmed for anterior cruciate ligament reconstruction and hip fracture repair.
• Increased surveillance for polymicrobial infections after TKA and Cutibacterium acnes after THA is recommended.