From the Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA (Prentice, Chan, and Paxton), Department of Internal Medicine, The Permanente Medical Group, South San Francisco, CA (Champsi, Clutter, and Fang), Department of Orthopedics, Southern California Permanente Medical Group, Baldwin Park, CA (Maletis), Department of Orthopedics, Southern California Permanente Medical Group, Irvine, CA (Mohan and Namba)Department of Orthopedics, Southern California Permanente Medical Group, San Diego, CA (Reddy), Department of Orthopedics, The Permanente Medical Group, San Leandro, CA (Hinman), Department of Orthopedics, Southern California Permanente Medical Group, Harbor City, CA (Navarro), Department of Orthopedics (Norheim), Southern California Permanente Medical Group, Bellflower, CA.
J Am Acad Orthop Surg. 2022 Nov 1;30(21):e1391-e1401. doi: 10.5435/JAAOS-D-22-00280. Epub 2022 Sep 7.
Centers of excellence and bundled payment models have driven perioperative optimization and surgical site infection (SSI) prevention with decolonization protocols and antibiotic prophylaxis strategies. We sought to evaluate time trends in the incidence of deep SSI and its causative organisms after six orthopaedic procedures in a US-based integrated healthcare system.
We conducted a population-level time-trend study using data from Kaiser Permanente's orthopaedic registries. All patients who underwent primary anterior cruciate ligament reconstruction (ACLR), total knee arthroplasty (TKA), elective total hip arthroplasty (THA), hip fracture repair, shoulder arthroplasty, and spine surgery were identified (2009 to 2020). The annual incidence of 90-day deep SSI was identified according to the National Healthcare Safety Network/Centers for Disease Control and Prevention guidelines with manual chart validation for identified infections. Poisson regression was used to evaluate annual trends in SSI incidence with surgical year as the exposure of interest. Annual trends in overall incidence and organism-specific incidence were considered.
The final study sample was composed of 465,797 primary orthopaedic procedures. Over the 12-year study period, a decreasing trend in deep SSI was observed for ACLR and hip fracture repair. Although there was variation in incidence rates for specific operative years for TKA, elective THA, shoulder arthroplasty, and spine surgery, no consistent decreasing trends over time were found. Decreasing rates of Staphylococcus aureus infections over time after hip fracture repair, shoulder arthroplasty, and spine surgery and decreasing trends in antibiotic resistance after elective THA and spine surgery were also observed. Increasing trends of polymicrobial infections were observed after TKA and Cutibacterium acnes after elective THA.
The overall incidence of deep SSI after six orthopaedic procedures was rare. Decreasing SSI rates were observed for ACLR and hip fracture repair within our US-based healthcare system. Polymicrobial infections after TKA and Cutibacterium acnes after elective THA warrant closer surveillance.
IV.
卓越中心和捆绑支付模式通过去定植方案和抗生素预防策略推动了围手术期优化和手术部位感染（SSI）的预防。我们试图评估美国综合医疗保健系统中 6 种骨科手术术后深部 SSI 的发生率及其病原体的时间趋势。
我们使用 Kaiser Permanente 的骨科登记处的数据进行了一项基于人群的时间趋势研究。所有接受初次前交叉韧带重建（ACLR）、全膝关节置换术（TKA）、择期全髋关节置换术（THA）、髋部骨折修复、肩关节置换和脊柱手术的患者均被确定（2009 年至 2020 年）。根据国家医疗保健安全网/疾病控制和预防中心的指南，通过对确定的感染进行人工图表验证，确定 90 天深部 SSI 的年度发生率。使用泊松回归评估 SSI 发生率的年度趋势，以手术年份为感兴趣的暴露。考虑了总体发生率和特定病原体发生率的年度趋势。
最终的研究样本由 465797 例初次骨科手术组成。在 12 年的研究期间，ACLR 和髋部骨折修复的深部 SSI 呈下降趋势。尽管 TKA、择期 THA、肩关节置换和脊柱手术的特定手术年份的发病率有所不同，但未发现随着时间的推移呈持续下降趋势。髋部骨折修复、肩关节置换和脊柱手术后金黄色葡萄球菌感染率呈下降趋势，择期 THA 和脊柱手术后抗生素耐药性呈下降趋势。TKA 后混合感染呈上升趋势，择期 THA 后 Cutibacterium acnes 呈上升趋势。
我们的美国医疗保健系统中，六种骨科手术后深部 SSI 的总体发生率较低。ACLR 和髋部骨折修复的 SSI 发生率呈下降趋势。TKA 后混合感染和择期 THA 后 Cutibacterium acnes 感染率增加，需要更密切的监测。
IV。
