This article is more than 5 years old. Information may no longer be current.
Hospital volume linked to hip arthroplasty SSI risk
Researchers gain insight into variables influencing SSI risk, a common complication after hip replacement surgery.
Click Here to Manage Email Alerts
Undergoing surgery in a hospital with low operation volume increases patient risk for surgical-site infection, according to researchers in the Netherlands.
Their study showed that a high annual volume of operations was associated with a reduced risk such infections. The risk of surgical-site infection (SSI) also decreased as the availability of full-time infection control staff members increased per 250 beds. The decrease in risk did not reach statistical significance, however.
Seven researchers, led by Eveline L.P.E. Geubbels, PhD, studied 36 acute care hospitals in The Dutch Network for Prevention of Nosocomial Infections Through Surveillance (PREZIES) over a four-year period. This network provides the only detailed surveillance system available in the Netherlands, according to the study.
The researchers limited the study to the procedure most frequently included in hospital surveillance: partial and total hip arthroplasty. They collected data for 13,680 patients, from which 458 SSIs developed.
Geubbels and her co-authors also interviewed the hospitals about the number of beds, university affiliation, annual volume of operations per procedure as well as the total number of additional full-time infection control staff available and the specific number available for SSI prevention.
Reduced SSI risk
“Undergoing a hip arthroplasty in a hospital with a higher annual volume of operations was the only studied variable associated with a significantly reduced risk of SSI,� the researchers said. Hospital size, university affiliation and the number of surgeons and their years of experience did not significantly influence SSI risk, they noted.
According to the study, the median hospital infection rate was 2.2% for total hip arthroplasty and 5.3% for partial hip replacement. The researchers also noted that one-fifth of all infections were detected post discharge.
“We found that a higher number of surgeries performed [actually] reduced the risk of SSI for a hospital,� the researchers said. Risk factors related to patients or procedures did not help to explain this finding.
“Our finding of a lower risk of SSI with higher hospital volume may be the result of differences in the technical skills of individual surgeons,� the researchers said.
“These findings may have implications for risk stratification of SSI rates that are used for comparison of hospitals or surgical teams,� they noted. However, the reason for a reduced SSI risk with a high hospital volume deserves further study, they added.
For more information:
- Geubbels ELPE, Wille JC, Nagelkerke NJD et al. Hospital-related determinants for surgical-site infection following hip arthroplasty. Infect Control Hosp Epidemiol. 2005;26:435-440.