Risk factors, bacteriological profile and outcome of surgical site infections following orthopaedic surgery

Shishir Murugharaj Suranigi; SR Ramya; C Sheela Devi; Reba Kanungo; Syed Najimudeen

doi:10.18502/ijm.v13i2.5976

Shishir Murugharaj Suranigi Department of Orthopaedics, Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka, India
SR Ramya Department of Microbiology, Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka, India
C Sheela Devi Department of Microbiology, Pondicherry Institute of Medical Sciences, Puducherry, India
Reba Kanungo Department of Microbiology, Pondicherry Institute of Medical Sciences, Puducherry, India
Syed Najimudeen Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Puducherry, India

DOI: https://doi.org/10.18502/ijm.v13i2.5976

Keywords: Surgical site infection; Orthopaedic procedure; Risk factors; Acinetobacter baumannii; Staphylococcus aureus; Financial burden

Abstract

Background and Objectives: Surgical site infection (SSI) is a challenge for the surgeon. Incidence of SSI reported in literature varies from 0.5% to 15%. Severity of SSI ranges from superficial skin infection to life-threatening condition like septicaemia. It is responsible for increased morbidity, mortality, and economic burden to the hospital in general, and the patient in particular. The aim of this study was to assess the risk factors, bacteriological profile, length of hospitalization, and cost due to orthopaedic SSI in patients admitted to a tertiary care hospital.

Materials and Methods: This was a prospective case control study. Cases were diagnosed based on CDC definition of nosocomial SSI. All cases were assessed preoperatively, intraoperatively and postoperatively, according to type of surgery, wound class, duration of operation, antimicrobial prophylaxis, use of drain, preoperative hospital stay, causative micro organism, total hospital stay, re-admission rates and cost incurred. Age, sex and surgical procedure matched controls without SSI, were also assessed. Chi- square test and Fisher's exact test were used for analysis. P= <0.05 was considered significant.

Results: Out of 1023 patients, 47 cases had SSI, with a rate of 4.6%. Cigarette smoking was a risk factor for SSI (P = 0.0035). The most common etiologic agents were Acinetobacter baumannii and Staphylococcus aureus. Incidence of re- admission among SSI cases was more compared to controls (P= 0.0001). Costs attributable to SSI (Indian Rupees) was Rs 32,542 (17,054 to 87,514) which was significantly more than those without SSI (P= <0.001).

Conclusion: Despite latest surgical amenities, meticulous sterilization protocols and pre-operative antibiotic prophylaxis, SSI continues to be present in healthcare settings. The increase in duration of hospital stay due to SSI adds to additional burden to an already resource-constrained healthcare system.