Investigating surgical site infection after hip fracture surgery
<p>Infection after surgery or surgical site infection (SSI) is a devastating complication for patients and healthcare providers. Hip fracture patients are particularly vulnerable to SSI, and its consequences. Despite its importance, there is uncertainty around the true rate of SSI. This parame...
| Egile nagusia: | |
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| Beste egile batzuk: | |
| Formatua: | Thesis |
| Hizkuntza: | English |
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2019
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| Gaiak: |
| _version_ | 1826317466080378880 |
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| author | Masters, JPM |
| author2 | Costa, M |
| author_facet | Costa, M Masters, JPM |
| author_sort | Masters, JPM |
| collection | OXFORD |
| description | <p>Infection after surgery or surgical site infection (SSI) is a devastating
complication for patients and healthcare providers. Hip fracture patients are particularly vulnerable to SSI, and its consequences. Despite its importance, there is uncertainty around the true rate of SSI. This parameter is crucially important to properly power studies that seek to assess interventions that may reduce SSI. One such intervention is the wound dressing. Some dressings including incisional Negative Pressure Wound Therapy (iNPWT) are used in
high-risk surgical wounds, and may reduce SSI. There is a need to assess in this
context.</p>
<p>Three contrasting methods were used to assess hip fracture patients. Firstly a
systematic review was undertaken of patients undergoing surgery in the United Kingdom. Data were extracted and meta-analysed. Secondly, administrative data
were explored to look at the incidence of SSI after hip fracture. Data were
additionally interrogated for evidence of treatment for SSI and possible risk factors for SSI. Finally a randomised controlled feasibility trial was undertaken comparing standard care to incisional negative pressure wound therapy in 464 patients. These patients were allocated on a 1:1 basis across 5 centres. Each
patient was assessed at 30 days and 90 days against the Centre for Disease Control definition of SSI. </p>
<p>The systematic review identified 20 studies of 88615 hip fracture patients. A
pooled estimate of 2.08% (95% CI 1.54-2.62) was seen in studies reporting SSI in
‘all hip fractures’. There was variation between types of surgery. The
administrative data gave an SSI estimate of between 1.4% (95% CI 1.2%-1.6%)
and 1.7% (95% CI 1.4%-2.0%). The feasibility study recruited all patients in 6
months. Eighteen patients were diagnosed with SSI according to the CDC criteria at 30 days-a rate of 4.2% (95% CI 2.5%-6.5%). At 120 days an additional new case of SSI was identified-a rate of 4.4% (95% CI 2.6%-6.8%).</p>
<p>The rate of SSI may be significantly higher than suggested by evidence synthesis
and national screening programmes. The data from published and administrative data show higher estimates of SSI, despite possible underestimates in each data source. Prospective studies using recognised criteria show even higher rates of
SSI.</p>
<p>The rate of surgical site infection appears to influenced by the study design and data collection procedure.</p> |
| first_indexed | 2024-03-07T06:48:00Z |
| format | Thesis |
| id | oxford-uuid:fb83b97f-d523-4e30-ac5a-d9ad2c8a7ae3 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2025-02-19T04:40:24Z |
| publishDate | 2019 |
| record_format | dspace |
| spelling | oxford-uuid:fb83b97f-d523-4e30-ac5a-d9ad2c8a7ae32025-02-12T14:49:05ZInvestigating surgical site infection after hip fracture surgeryThesishttp://purl.org/coar/resource_type/c_db06uuid:fb83b97f-d523-4e30-ac5a-d9ad2c8a7ae3Orthopaedic TraumaEnglishHyrax Deposit2019Masters, JPMCosta, MJudge, A<p>Infection after surgery or surgical site infection (SSI) is a devastating complication for patients and healthcare providers. Hip fracture patients are particularly vulnerable to SSI, and its consequences. Despite its importance, there is uncertainty around the true rate of SSI. This parameter is crucially important to properly power studies that seek to assess interventions that may reduce SSI. One such intervention is the wound dressing. Some dressings including incisional Negative Pressure Wound Therapy (iNPWT) are used in high-risk surgical wounds, and may reduce SSI. There is a need to assess in this context.</p> <p>Three contrasting methods were used to assess hip fracture patients. Firstly a systematic review was undertaken of patients undergoing surgery in the United Kingdom. Data were extracted and meta-analysed. Secondly, administrative data were explored to look at the incidence of SSI after hip fracture. Data were additionally interrogated for evidence of treatment for SSI and possible risk factors for SSI. Finally a randomised controlled feasibility trial was undertaken comparing standard care to incisional negative pressure wound therapy in 464 patients. These patients were allocated on a 1:1 basis across 5 centres. Each patient was assessed at 30 days and 90 days against the Centre for Disease Control definition of SSI. </p> <p>The systematic review identified 20 studies of 88615 hip fracture patients. A pooled estimate of 2.08% (95% CI 1.54-2.62) was seen in studies reporting SSI in ‘all hip fractures’. There was variation between types of surgery. The administrative data gave an SSI estimate of between 1.4% (95% CI 1.2%-1.6%) and 1.7% (95% CI 1.4%-2.0%). The feasibility study recruited all patients in 6 months. Eighteen patients were diagnosed with SSI according to the CDC criteria at 30 days-a rate of 4.2% (95% CI 2.5%-6.5%). At 120 days an additional new case of SSI was identified-a rate of 4.4% (95% CI 2.6%-6.8%).</p> <p>The rate of SSI may be significantly higher than suggested by evidence synthesis and national screening programmes. The data from published and administrative data show higher estimates of SSI, despite possible underestimates in each data source. Prospective studies using recognised criteria show even higher rates of SSI.</p> <p>The rate of surgical site infection appears to influenced by the study design and data collection procedure.</p> |
| spellingShingle | Orthopaedic Trauma Masters, JPM Investigating surgical site infection after hip fracture surgery |
| title | Investigating surgical site infection after hip fracture surgery |
| title_full | Investigating surgical site infection after hip fracture surgery |
| title_fullStr | Investigating surgical site infection after hip fracture surgery |
| title_full_unstemmed | Investigating surgical site infection after hip fracture surgery |
| title_short | Investigating surgical site infection after hip fracture surgery |
| title_sort | investigating surgical site infection after hip fracture surgery |
| topic | Orthopaedic Trauma |
| work_keys_str_mv | AT mastersjpm investigatingsurgicalsiteinfectionafterhipfracturesurgery |