A continuous record of postoperative surgical infections was carried out by electronic data processing of 9,181 orthopaedic and general operations. The overall infection rate was 5.7%, ranging from 2.0% (clean wounds) to 22.1% (dirty wounds). The corresponding deep infection rates were 1.7%, 0.4% and 5.4%, respectively. Employing a multiple logistic regression analysis, ten risk factors were evaluated. Factors found to be significant for both departments were: wound contamination, duration of operation and age. In addition, in the department of orthopaedic surgery: date of operation and surgeon, and in the department of general surgery: planning of operation, length of preoperative stay and anatomic groups. Sex had no influence on postoperative infection. Significant factors altered during the four years. Postoperative stay was, on an average, 13.9 days longer in infected patients.
The incidence of postoperative surgical site infections (SSIs) is difficult to estimate because of the current trend of early discharge after surgery. Both operation-related and host factors should be taken into consideration in the prevention of SSIs. We wanted to determine the actual incidence of SSIs and evaluate the risk factors in our clinic, using an extended follow-up period of 30 days after operations.
We performed a prospective follow-up survey of SSIs over a 3.5-month period including a 1-month follow-up after discharge with written instructions and a telephone survey. The SSIs were defined according to Centers for Disease Control and Prevention criteria. Forty-three patient parameters were recorded, and risk factors for SSI were sought and tested by using multiple logistic regression analysis.
The follow-up was completed in 772 of 807 patients. The SSI rates in these patients were 5.3% in clean, 7.1% in clean-contaminated, 6.2% in contaminated, and 28.1% in dirty operations. Seventy-one percent of infections were not diagnosed until after discharge from the hospital. According to multiple logistic regression analysis, alcohol abuse (p
Post-operative wound infections are serious complications in cardiovascular surgery. In order to examine the routines for prophylactic antibiotics and frequency of wound infections, questionnaires were sent to heart and vascular surgery units in Norway. In heart surgery, the sternal wound infection rate registered during stay in hospital varied between 0-1.2%. Seven clinics used cephalothin prophylaxis and one cloxacillin and penicillin. One clinic added vancomycin in the case of valvular surgery. The duration of prophylaxis varied from six hours to four days. In vascular surgery, superficial wound infection rates of 1.5-4.0%, and deep infection rates of 0.8-2.0%, were reported. Seven clinics used cephalothin and three cefuroxime as prophylaxis. The duration of prophylaxis varied from one single dose to several days. In conclusion, the reported infection rates indicate that the antibiotic prophylaxis regimens used help to provide satisfactory protection against wound infections.
The Norwegian Patient Compensation System (NPCS) was started up in January 1988. By the end of 1999, a total of 15,552 complaints had been received. This paper reviews the outcome of the complaint procedures in the field of orthopaedics.
From 1993 to 1999, the NPCS assessed a total of 8,520 complaints of which 4,041 (47%) were in orthopaedics. On the basis of abstracts of these cases, we retrieved more detailed information.
Over the period, 39% of orthopaedic complaints resulted in compensation, with a decline from 45% in 1993 to 32% in 1999. 328 orthopaedic patients were awarded compensation on the basis of infection; they constituted 8% of all compensated claims and 21% of all compensated orthopaedic claims. These ratios remained fairly constant throughout the period. Compensation was given to 291 patients with loosening of prostheses following use of Boneloc cement; these cases represented 7% of all orthopaedics claims and 18% of all compensated claims. Complaints were most numerous in 1996 and 1997; this reflected the use of this cement in the early 1990s. Rejected complaints were appealed with increasing frequency; in 1999, 46% of all NPCS cases were appealed, 33% of all orthopaedic cases. Rejections overruled following appeal were within a range of 16% (1994) and 11% (1995). When initial rejections overruled on appeal are included, the total compensation-to-claims ratio increases from 39% to 41%.
The high number of complaints in orthopaedics probably reflects the high frequency of musculoskeletal disorders in the population. It is to be hoped that evaluation of treatment injuries will result in a higher quality of patient treatment.
A continuous record of postoperative surgical infections was carried out by electronic data processing (EDP) of 4340 orthopaedic and general operations. The overall infection rate was 6.3%, ranging from 2.3% (clean wounds) to 27.1% (dirty wounds). The corresponding deep infection rates were 1.6%, 0.4% and 4.6%. Employing a multiple logistic regression analysis, 10 risk factors were evaluated. Factors found to be significant were: wound contamination, department, duration of operation, date of operation and age, and in addition for the department of general surgery: surgeon, planning of operation, length of preoperative stay and anatomic groups. A statistical model for identification of risk patients is described. Postoperative stay was on average 20.5 days longer in infected patients. We find that EDP-recording may result in an annual cost reduction of at least 175,000 pounds for our hospital.
The objective was to identify risk factors for shunt infections, and establish the rate of infection for shunt procedures carried out under standardized conditions in a well-defined population. All (407) paediatric shunt operations (primary and revisions) performed within a total population of 630000 inhabitants between January 1, 1986 and December 31, 1996, were analysed retrospectively. 11 shunt infections were diagnosed in 10 patients, giving an overall infection rate of 2.7% per procedure and 6.2% per patient. Infections were significantly correlated with age, type of operation, and a etiology of hydrocephalus. Thus, infections occurred more frequently during the first 6 months of life, more often following primary shunt insertions compared with revisions, and children with myelomeningocele had a higher infection risk than children with hydrocephalus due to other causes. There was a highly significant male preponderance in the patient material. Conclusion: The overall infection rate was relatively low. The risk factors for shunt infections appear to relate to epidemiological characteristics rather than to surgical factors.
A retrospective cohort study was conducted to determine the incidence of post-caesarean infections in a Canadian community teaching hospital using computer algorithms designed for the diagnosis of nosocomial infections. Inferential chart review was done on 1335 women delivered by lower-segment caesarean section (793 primary and 542 secondary) at the Calgary General Hospital between January 1985 and April 1988. The overall infection rates were 42.1 and 46.1% for women delivered by primary and secondary caesarean section, respectively. Incisional surgical wound infection accounted for the largest proportion of post-caesarean infections found. Women delivered by primary caesarean section had significantly higher rates of endometritis, deep surgical wound infection and bacteraemia than those delivered by secondary section. All types of post-caesarean infection, except asymptomatic bacteriuria, caused the duration of the post-partum hospital stay to be significantly increased.
OBJECTIVE: To evaluate whether vaginal cleansing reduces the risk of postoperative infection after abdominal total hysterectomy on benign indications and to analyze risk factors. DESIGN: Retrospective cohort study. SETTING: All clinics including patients in the Swedish National Register for Gynecological Surgery. POPULATION: All 7,193 women who underwent abdominal total hysterectomy for benign indications from 2000 to 2007. METHODS: Information on clinic routines for preoperative vaginal cleansing was obtained retrospectively in a postal survey. Associations between routines for vaginal cleansing and structured data from the Register were analyzed by means of multivariate logistic regression models. The main effect variable was postoperative infections defined as infections treated with antibiotics within six to eight weeks postoperatively, reported by the patient or the physician. MAIN OUTCOME MEASURES: Prevalence and risk factors for postoperative infections. RESULTS: Prevalence of postoperative infections was 14.4%. The prevalence did not differ between those having had vaginal cleansing using chlorhexidine and those without vaginal cleansing, whereas using saline solution was encumbered with a significantly increased risk. Risk factors for postoperative infections were age >60, obesity, smoking, weight of the uterus, duration of hospital stay, blood transfusion, and peroperative injury of the urinary bladder or ureter. CONCLUSION: Vaginal cleansing using chlorhexidine solution did not reduce the risk of postoperative infections, whereas vaginal cleansing using saline solution seemed to increase the risk. Some risk factors for postoperative infectious morbidity seem to be preventable.