title: Evaluation of postdischarge surveillance of surgical site infections after total hip and knee arthroplasty.
abstract: BACKGROUND
  Artificial joint replacement of hip (HPRO) and knee (KPRO) are 2 of about 20 categories of operative procedures of the surveillance of surgical site infection (SSI) as stated by nosocomial infections surveillance systems in the United States and in Germany. Periprosthetic SSI can manifest itself after a long period.
  
  
  METHODS
  Seven hundred fifty-six orthopedic patients from 2 centers were evaluated after HPRO (n = 508) or KPRO (n = 248). SSI was recorded during hospitalization and for 12 month postdischarge. The surveillance regimen was extended by also sending patients a questionnaire after 12 months postdischarge. All complaints were followed up by contacting the patients and any clinicians and general practitioners (GPs) involved. Stratified infection rates and standardized infection ratio (SIR) were calculated and compared with reference data of the national surveillance system.
  
  
  RESULTS
  The total response rate to the postal questionnaire survey was 85.2%. SSI was recorded in 16 patients (3.15%) after HPRO; 12 were detected by predischarge surveillance, and the 4 cases found postdischarge were all organ/space SSI. In total, only 1 SSI was detected after KPRO before discharge and none after discharge (SSI rate 0.40%). Time between discharge and detection of SSI cases ranged from 8 days to 8 months. SIR of HPRO was 1.25 and SIR of KPRO was 0.36.
  
  
  CONCLUSIONS
  Because 25% of SSIs after HPRO occurred after discharge and all were organ/space SSI, highlights the importance of postdischarge surveillance of nosocomial infections (NIs). Because all SSIs were reported already by current surveillance, the extended postdischarge surveillance appears to be unnecessary. The pursuit of shorter hospital stay after surgery may challenge the methods of surveillance systems in future.
authors.affiliation: Department of Infection Control, University Hospital RWTH Aachen, Aachen, Germany. fhuenger@ukaachen.de
authors.forename: Frank
authors.initials: F
authors.lastname: Huenger
authors.forename: Adriane
authors.initials: A
authors.lastname: Schmachtenberg
authors.forename: Helga
authors.initials: H
authors.lastname: Haefner
authors.forename: Dirk
authors.initials: D
authors.lastname: Zolldann
authors.forename: Katharina
authors.initials: K
authors.lastname: Nowicki
authors.forename: Dieter C
authors.initials: DC
authors.lastname: Wirtz
authors.forename: Klaus
authors.initials: K
authors.lastname: Bläsius
authors.forename: Rudolf
authors.initials: R
authors.lastname: Lütticken
authors.forename: Sebastian W
authors.initials: SW
authors.lastname: Lemmen
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006761:Hospitals; D006801:Humans; D008297:Male; D010351:Patient Discharge; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology; D011795:Surveys and Questionnaires