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Problem of postoperative surgical site infection still needs to be solved
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Postoperative surgical site infections have long been an issue that has concerned many surgeons, but only a few of them really looked closely at this problem and developed strategies and guidelines to prevent and effectively treat surgical site infections. Therefore, I am glad organizations within Europe, like the European Bone and Joint Infection Society, have gained more visibility as of late and improved their impact in this area. Their efforts ultimately assist all orthopaedic surgeons in understanding the best approaches to the prevention and treatment of infection.
The main theme selected for the upcoming EFORT Congress in Prague this May is infection. An intense education program has been set that includes instructional lectures, symposia and debate forums to provide attendees with updated information on infection to add to their current knowledge base in this area.
I do not suppose post-surgical infection will ever completely disappear, but I believe more can and must be done to minimize its occurrence. Also, the true incidence of postoperative surgical site infection (SSI) is probably higher than most of us think it is. In a paper I and my colleagues had published in Acta Orthopaedica, we traced all potential postoperative deep infections after total hip replacement (THR) in all of Denmark through the national hip arthroplasty register, national patient hospitalization registry, national registry for outcome of tissue culturing, and national drug prescription registry. In observed cases where it was unclear from the registries whether infection was present, we reviewed the individual patients’ records to either confirm or remove the statement of a suspected deep infection. From that process we found a 40% higher verified deep infection rate than what was listed in the national hip arthroplasty registry.
We expected a higher incidence of infection, but certainly not that much greater an incidence.
Therefore, from this study, we concluded the incidence of postoperative SSIs is generally under-reported, which makes the entire problem of SSIs even bigger than initially thought.
Immediate action in this regard is needed on all levels. Orthopaedic and trauma departments must create responsible teams who will diagnose, observe and treat these patients. Leaders throughout the field of orthopaedics should facilitate the open debate of the urgent questions that surround infections. We must move from an attitude of being ashamed of having cases of infection to one where we assist and support each other any way we can to reduce the incidence of infection and effectively treat patients with this type of surgical complication.
To be a patient with deep infection after THR, for example, is a “disaster” after what was hoped would be a recovery that was quick and restored function. Instead the patient is faced with a long recovery and a greater risk of a negative outcome. These patients need our utmost attention. This is why I believe the time has come for all stakeholders, including governments, health authorities, hospital systems and physicians, to focus their energies on postoperative SSIs. With our combined efforts, we can help minimize pain and suffering among patients, improve the skill among the orthopaedic community to diagnose and treat SSIs and reduce overall costs related to infection.
- Reference:
- Gundtoft PH, et al. Acta Orthop. 2015;30:1-9. [Epub ahead of print].
- For more information:
- Per Kjaersgaard-Andersen, MD, is Chief Medical Editor of Orthopaedics Today Europe. He can be reached at Orthopaedics Today Europe, 6900 Grove Rd., Thorofare, NJ 08086, USA; email: orthopaedics@healio.com.
Disclosure: Kjaersgaard-Andersen reports no relevant financial disclosures.