title: Surgical site infection after primary hip and knee arthroplasty: a cohort study using a hospital database.
abstract: BACKGROUND
  Hip or knee arthroplasty infection (HKAI) leads to heavy medical consequences even if rare.
  
  
  OBJECTIVE
  To assess the routine use of a hospital discharge detection algorithm of prosthetic joint infection as a novel additional tool for surveillance.
  
  
  METHODS
  A historic 5-year cohort study was built using a hospital database of people undergoing a first hip or knee arthroplasty in 1 French region (2.5 million inhabitants, 39 private and public hospitals): 32,678 patients with arthroplasty code plus corresponding prosthetic material code were tagged. HKAI occurrence was then tracked in the follow-up on the basis of a previously validated algorithm using International Statistical Classification of Disease, Tenth Revision, codes as well as the surgical procedures coded. HKAI density incidence was estimated during the follow-up (up to 4 years after surgery); risk factors were analyzed using Cox regression.
  
  
  RESULTS
  A total of 604 HKAI patients were identified: 1-year HKAI incidence was1.31%, and density incidence was 2.2/100 person-years in hip and 2.5/100 person-years in knee. HKAI occurred within the first 30 days after surgery for 30% but more than 1 year after replacement for 29%. Patients aged 75 years or older, male, or having liver diseases, alcohol abuse, or ulcer sore had higher risk of infection. The inpatient case fatality in HKAI patients was 11.4%.
  
  
  CONCLUSIONS
  The hospital database method used to measure occurrence and risk factors of prosthetic joint infection helped to survey HKAI and could optimize healthcare delivery.
authors.affiliation: 1Service d'Information Médicale,d'Epidémiologie et d'Economie de la Santé,Centre Hospitalier Régional Universitaire de Tours,Laboratoire de santé publique,Université François Rabelais,Tours,France.
authors.forename: Leslie
authors.initials: L
authors.lastname: Grammatico-Guillon
authors.affiliation: 2Unité régionale d'épidémiologie hospitalière,Centre Hospitalier Régional Universitaire de Tours,France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Baron
authors.affiliation: 3Service de chirurgie orthopédique,Centre Hospitalier Régional Universitaire Tours,Université François Rabelais,Tours,France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rosset
authors.affiliation: 2Unité régionale d'épidémiologie hospitalière,Centre Hospitalier Régional Universitaire de Tours,France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Gaborit
authors.affiliation: 4Service de Médecine Interne et Maladies Infectieuses,Centre Hospitalier Régional Universitaire Tours,Université François Rabelais,Tours,France.
authors.forename: Louis
authors.initials: L
authors.lastname: Bernard
authors.affiliation: 1Service d'Information Médicale,d'Epidémiologie et d'Economie de la Santé,Centre Hospitalier Régional Universitaire de Tours,Laboratoire de santé publique,Université François Rabelais,Tours,France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Rusch
authors.affiliation: 5Ecole des Hautes Etudes en Santé Publique & Centre de coordination pour la lutte contre les infections associées aux soins,Paris,France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Astagneau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011159:Population Surveillance; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult