title: Impact of postdischarge surveillance on the rate of surgical site infection after orthopedic surgery.
abstract: OBJECTIVE
  To evaluate the impact of postdischarge surveillance on surgical site infection (SSI) rates after orthopedic surgery.
  
  
  METHODS
  Nine hospitals participating in the Finnish Hospital Infection Program.
  
  
  METHODS
  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.
authors.affiliation: National Public Health Institute, Helsinki, Finland. kaisa.huotari@ktl.fi
authors.forename: Kaisa
authors.initials: K
authors.lastname: Huotari
authors.forename: Outi
authors.initials: O
authors.lastname: Lyytikäinen
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects*; D010351:Patient Discharge; D011159:Population Surveillance / Q000379:methods*; D011182:Postoperative Care / Q000592:standards*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D011795:Surveys and Questionnaires