Page 3
These infections account for 3% of all surgical mortality and lead to increased readmissions, increased lengths of hospital stays, and higher costs.1 Patients who develop an SSI are 5 times more likely to be readmitted to the hospital, 60% more apt to require stay in an inten-sive care unit (ICU), and twice as likely to die compared with patients who are free of infection.2 Evidence further suggests that patients who contract multidrug-resistant infections face worse outcomes.5,7The financial burden of SSIs is sizeable. An extensive epidemiologic review of surgical patient data revealed that lengths of hospital stay postoperatively extend 7 to 10 days, while hospital charges ranged from $3,000 to $29,000 per patient with a SSI diagnosis.3,5 Annually, hospital-acquired infections (HAIs) cost the healthcare system $9.8 billion.8 Compared with all HAIs nation-wide, SSIs occur most often and contribute the most to the overall cost, at 37.7% of the total cost.8 Death in the postoperative period was directly related to SSIs in 75% of patients in whom an SSI was diagnosed.3The infection risk associated with primary hip and knee arthroplasty is approximately 1% and increases to 2% to 5% for arthroplasty revision.7 Compared with the infection rate for colon surgery, which is 20%, SSI rates in orthopedic surgery appear quite low. However, infec-tion in the bones and joints is very difficult to treat and is associated with a lifelong recurrence risk of 10% to 20%.9 When multiresistant pathogens such as methicillin-re-sistant Staphylococcus aureus (MRSA) infect a prosthetic joint, the treatment failure rate is 20% to 40%.7 Surgical infections that occur after total hip and knee arthroplasty are very costly and devastating for patients.7 Treatment of SSIs following joint replacement often requires removal and replacement of the prosthesis, prolonged systemic antibiotic therapy, and extensive rehabilitation because of impaired mobility.The probability of an SSI developing is dependent on both surgical procedure characteristics and patient risk factors. Surgical characteristics include the type of procedure, skill of the surgeon, use of foreign material or implantable devices, and the degree of tissue trauma.10 Evidence has documented several patient risk factors as-sociated with higher frequency of SSIs, including diabe-tes, tobacco use, obesity, malnutrition, systemic steroid use or other immunosuppressive drugs, duration of the operation, and intraoperative hypothermia.11-13A study of 5,031 Veterans Administration patients with postsurgical incisions revealed that SSIs occurred in162 cases, or 3.2% of the cohort.