الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 215 |  |  |
| | | from | 215 | | |
Abstract
Summary
Introduction
The success of total hip arthroplasty (THA) in relieving pain and improving function in patients with end-stage degenerative or inflammatory arthritis of the hip is undisputed. The number of procedures per year is estimated to further rise in the next years, as even younger patients with hip arthritis are expected to seek surgical treatment.
To prevent confusion between the infection of a surgical incision and the infection of a traumatic wound, most SSIs are superficial, but even so they contribute greatly to the morbidity and mortality associated with surgery.
Surgical site infection is considered to be the third most commonly reported nosocomial infection. SSI is responsible for longer hospitalization and higher cost in patients, which results in social and economic loss to the patients and family.
The risk factors/predictors responsible for SSIs are considered to be highly diverse in nature. The occurrence of SSIs depends on a number of factors including patient health status (pre-morbid conditions such as diabetes and hypertension), length of hospital stays and patient level of education, the type of surgical intervention performed, sterilization procedures and use of any pre-operative antibiotics and the quality of the facility of postoperative surgical care. For this purpose, it is important to have accurate data on SSIs in order to optimize patient health outcome and to prioritize healthcare funding.
Considering the serious consequences of SSI for hip fracture patients it is important to optimize modifiable risk factors. However, reported risk factors differ, ranging from operative delay to the lead surgeon’s experience, duration of surgery, choice of implant, and patient factors such as obesity.
The prevalence and incidence rate of surgical wound infections vary usually between hospitals, surgeons, patient, procedures, patients and geographical locations.
In The light of above facts, the present study was designed to assess the risk factors/predictors for such infections following hip replacement along with their clinical outcomes.
Significance of the study:
Surgical site infection is considered one of the most common causes of hospital acquired infections, accounting for 20 - 25% of all HAI all over the world.
In Egypt, a study which was conducted to estimate the risk factors and major pathogens involved in surgical site infections in an orthopedic hospital in Cairo detected an overall wound infection rate of 25.8%.
Although SSIs following total joint arthroplasty are not so frequent, they are associated with severe complications that can subsequently require a longer postoperative hospital stay, rehospitalization, reoperation, temporary prosthesis removal, and prolonged antimicrobial therapy. furthermore, they can reduce patient functionality, increase mortality, and lead to excess treatment costs.
Orthopedic SSI is a health problem occurring for patients undertaking orthopedic surgical procedures. periprosthetic joint infection (PJI) is also correlated with increased mortality, particularly in the group of elderly patients.
The rate of surgical site infection (SSI) has been reported to range from 2.0% during hospitalization to 1.1% up to 5 years after surgery Therefore, the projected increase in the number of total hips arthroplasty THA will also reflect a respective increase in the absolute number of patients presenting with this complication.
Aim of the study:
Consequently, this study was conducted and aimed to assess of predictors of surgical site infection among patients with total hip replacement, assess clinical outcomes of surgical site infection among patients with total hip replacement and identify relationship between predictors of surgical site infection among patients with total hip replacement and their clinical outcomes.
This descriptive exploratory research design was conducted at orthopaedic unit, ICU and orthopaedic outpatient clinic affiliated to Ain Shams University, Al Hellal and El Hussein University Hospitals. A purposeful sample of all available hip replacement patients have surgical site infection were recruited to this study during one year. Study subjects included a representative of total patients in orthopedic unit, ICU and orthopedic outpatient clinic affiliated attendance rate; were hospitalized during the period 2021. Based on sample size equation 123 patients were participated in the study.
An interview questionnaire sheet was designed to assess predictors and clinical outcomes of surgical site infection among patients with total hip replacement. Patients’ medical records were used to obtain the past and present medical history, treatment …etc.
Results:
Our results showed that 42.3% of the studied patients were in age group >50-65 years old with mean age 56.81 + 12.5 years and 59.4% of them were females. Also, 51.3% of them had secondary education and 54.4% of them were not occupied / housewives.
Additionally, 63.4% of them reported not enough income and 52.8% of them had no health insurance. 63.4% of the studied patients had chronic disease where HTN and DM were the most common chronic disease among 71.7% and 41.1% of them. While, 72.3% of the studied patients had no surgical history and 54.6% of them had no family history of bone and joint disease.
Also, 64.3% of the studied patients reported no previous hospitalization. Additionally, 62.6% of the studied patients had regular medication regimen. While, 56.1% of the studied patients were nonsmokers and 100.0% of them were non-alcohol abuser. 55.3% of the studied patients were overweight. Also, 86.9% of them were hospitalized for less than 3 days preoperative.
Hip osteoarthritis was the most common indication for THR among 65.9% of them. Method of hair removal was razor among 60.2% of them and 58.5% of them took preoperative shower at previous night. Povidone iodine was the most common antiseptic solution used preoperatively. 49.5 % of the studied patients were in group II ASA and 91.1% of them were in group I of surgical wound classification.
Regarding to preoperative labs, 87.9%, 94.3% and 95.9% of the studied patients had normal level of WBCs, CRP and ESR respectively. Operative duration was ≤ 3 hours among 89.4 % of the studied patients and 68.3% of them underwent general anesthesia. Hand wash before operation last for 3-5 minutes among 78.8% of them and Povidine iodine was the most common antiseptic solution used among 82.9% of them. There were ≤6 persons in the operation theater among 63.4% of the studied patients.
Also, 72.3% of the studied patients had intraoperative blood transfusion and only 4.8% of them had blood transfusion reaction. Additionally, antibiotic had been administrated intraoperative among 94.3% of them. Surgical staples were the most common suture used among 56.1% of the studied patients.
About 76.5% of the studied patients stayed in hospital for ≤7 days after operation and 100.0% of them had drain in surgical site. The first dressing was post 72hrs form operation among 65.1% of them and 60.9% of them started mobility during the first 24 hour postoperatively. Regarding to post-operative labs, 74.7%, 69.9% and 79.6% of the studied patients had normal level of WBCs, CRP and ESR respectively.
About 26.8% of the studied patients had surgical site infection and 9.7 % of them readmitted to hospital due to surgical site infection. Also, 4.1% of them readmitted to operation due to surgical site infection and underwent deep debridement.
There was a significant statistical relationship between occurrence of surgical site infection among the studied patients and their gender and occupation at P- value =0.008 and 0.032 respectively. While, there was no significant statistical relationship between occurrence of surgical site infection among the studied patients and their age, education and income at P- value =0.370, 0.114 and 0.330 respectively.
There was a significant statistical relationship between occurrence of surgical site infection among the studied patients and their history of chronic illness at P-value=0.049 with the adjusted odds ratio 1.778 (0.741-4.262). Also, there was a significant statistical relationship between occurrence of surgical site infection among the studied patients and their history of regular medications at P-value= 0.024 with the adjusted odds ratio 1.231(0.553-2.739). While, there was no significant statistical relationship between occurrence of surgical site infection among the studied patients and their surgical history and smoking at P- value =0.689 and 0.611 respectively.
There was a significant statistical relationship between occurrence of surgical site infection among the studied patients and their BMI at P-value=0.027with the adjusted odds ratio 0.743(0.330-1.673). Also, there was a significant statistical relationship between occurrence of surgical site infection among the studied patients and time of preoperative shower at P-value= 0.014.
While, there was no significant statistical relationship between occurrence of surgical site infection among the studied patients and their length of hospital stay, indication of surgery, method of hair removal and type of antiseptic solution used at P- value =0.302, 0.991 0.130 and 0.222 respectively.
There was a significant statistical relationship between occurrence of surgical site infection among the studied patients and their ASA at P-value=0.005 with the adjusted odds ratio 2.150 (0.841-5.495).
While, there was no significant statistical relationship between occurrence of surgical site infection among the studied patients and their preoperative WBCs, CRP and ESR at P- value =0.092, 0.062 and 0.087 respectively.
There was a significant statistical relationship between occurrence of surgical site infection among the studied patients and their operative duration at P-value=0.005 with the adjusted odds ratio 2.150 (0.841-5.495). Also, occurrence of surgical site infection was significantly related to number of persons in operation theater was at P-value=0.012 with the adjusted odds ratio 0.357(0.157-0.811) and preoperative administration of antibiotic at P-value=0.006 with the adjusted odds ratio 0.127(0.023-0.693).
While, there was no significant statistical relationship between occurrence of surgical site infection among the studied patients and anesthesia type, duration of hand wash, type of antiseptic solution used, intraoperative blood transfusion and types of suture at P-value=0.122, 0.313, 0.843, 0.126 and 0.522 respectively.
There was a significant statistical relationship between occurrence of surgical site infection among the studied patients and length of hospital stay after operation at P-value=0.005 with the adjusted odds ratio 3.538(0.206-1.217).
While, there was no significant statistical relationship between occurrence of surgical site infection among the studied patients and type of implant, first dressing and time of start patient mobility after operation at P-value=0.269, 0.153 and 0.640 respectively.
There was a significant statistical relationship between occurrence of surgical site infection among the studied patients and postoperative WBCs, CRP and ESR at P-value=0.000, 0.007 and 0.000 respectively
Conclusion:
In conclusion, preventive measures must be taken from multiple perspectives to reduce the incidence of surgical site infection after joint replacement surgery.