Impact of postdischarge surveillance on the rate of surgical site infection after orthopedic surgery

Infect Control Hosp Epidemiol. 2006 Dec;27(12):1324-9. doi: 10.1086/509840. Epub 2006 Nov 21.


Objective: To evaluate the impact of postdischarge surveillance on surgical site infection (SSI) rates after orthopedic surgery.

Setting: Nine hospitals participating in the Finnish Hospital Infection Program.

Patients: All patients who underwent hip or knee arthroplasty or open reduction of a femur fracture during 1999-2002.

Results: The date of discharge was available for 11,812 procedures (90%). The median length of hospital stay was 8 days (range per hospital, 6-9 days). The overall SSI rate was 3.3% (range, 0.8%-6.4%). Of 384 SSIs detected, 216 (56%; range, 28%-90%) were detected after discharge: 93 (43%) were detected on readmission to the hospital, 73 (34%) at completion of a postdischarge questionnaire, and 23 (11%) at a follow-up visit. For 27 postdischarge SSIs (13%), the location of detection was unknown. Altogether, 32 (86%) of 37 of organ/space SSIs, 57 (80%) of 71 deep incisional SSIs, and 127 (46%) of 276 superficial incisional SSIs were detected after discharge. Most SSIs (70%) detected on readmission were severe (organ/space or deep incisional), whereas most SSIs (86%) detected at follow-up visits or at completion of a postdischarge questionnaire were superficial. Of all SSIs, 78% (range, 48%-100%) were microbiologically confirmed. Microbiologic confirmation was less common after discharge than during postoperative hospital stay (66% vs 93%; P<.001).

Conclusions: Postdischarge surveillance had a large impact on the rate of SSI detected after orthopedic surgery. However, postdischarge surveillance conducted by means of a questionnaire detected only a minority of deep incisional and organ/space SSIs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip / adverse effects
  • Arthroplasty, Replacement, Knee / adverse effects
  • Cross Infection / epidemiology
  • Cross Infection / prevention & control
  • Female
  • Hospitals
  • Humans
  • Length of Stay
  • Male
  • Orthopedic Procedures / adverse effects*
  • Patient Discharge*
  • Population Surveillance / methods*
  • Postoperative Care / standards*
  • Surgical Wound Infection / epidemiology*
  • Surgical Wound Infection / etiology
  • Surgical Wound Infection / microbiology
  • Surveys and Questionnaires