Incidence and Risk Factors for Deep Surgical Site Infection After Primary Total Hip Arthroplasty: A Systematic Review
Section snippets
Criteria for Including Studies
We included studies in this review that (i) were observational in design, (ii) were published between January 2000 and June 2008 (and reported data after 1990) due to significant changes in hip prostheses and postsurgical management over time, (iii) investigated deep SSI (but were not limited to a specific pathogen), (iv) included more than 100 patients who had unilateral or bilateral primary THA surgery, and (v) reported data on the incidence and/or risk factors for deep SSI, not on specific
Study Identification
From our electronic searches of MEDLINE, EMBASE and CINAHL, we identified 328, 272 and 14 potentially relevant abstracts respectively. From these 614 abstracts, we identified 21 studies that needed to be considered in detail to determine their relevance. Ten studies met our inclusion criteria 5, 6, 7, 8, 12, 13, 14, 15, 16, 17. Eleven studies were excluded as they (i) were not published in English 18, 19, (ii) had a sample size less than 100 20, 21, (iii) did not specifically investigate deep
Discussion
This systematic review found that the incidence of SSI ranged from 0.2% before discharge to 1.1% for the period up to and including 5 years postsurgery. Greater severity of a pre-existing illness and a longer duration of surgery were found to be independent risk factors for deep SSI. Given that single cohort studies only provided limited evidence for an association between a number of patient and hospital-related risk factors and deep SSI, there is a need for high quality, prospective studies
Acknowledgments
This study was funded by the HCF Health and Medical Research Foundation. DU, FH, and AW were supported by NHMRC Fellowships (grant nos. 284402, 418961, and 317840 respectively) and SB by an NHMRC PhD scholarship (519404).
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Supplementary material available at www.arthroplastyjournal.org.
Benefits or support were received from the HCF Health and Medical Research Foundation. National Health and Medical Research Council Fellowship and PhD Schemes.
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Joint first author.