New Infection Risk Assessment Tool

How much can we know—preoperatively—about the risk of postoperative surgical site infection (SSI)? Advances in this area are now available thanks to new research performed at the Wexner Medical Center at The Ohio State University. Joshua Everhart, M.D., a co-author on the paper, worked with colleagues to develop a preoperative SSI risk-assessment tool for primary or revision knee and hip arthroplasty.

Dr. Everhart told OTW, “As reimbursement after knee and hip arthroplasty has become increasingly tied to quality ratings (including infection rates), there has been a growing interest in infection risk assessment. Our group felt that development of a preoperative infection risk assessment tool was both timely and biologically plausible given the very large (and growing) body of literature linking patient comorbidities to surgical-site infection risk.

“A large proportion of surgical site infections occur in patients that are immunocompromised to some degree by their medical comorbidities. Our study shows that infection risk due to medical comorbidities can actually be quantified with some accuracy in the preoperative setting.

“I think the infection risk assessment tool will become a valuable component of hip and knee arthroplasty surgeons’ preoperative assessments. In particular, I think the assessment tool will enable surgeons to more effectively discuss the risk-benefit profile of surgery with patients. Every circumstance is different, and in some instances even a very high score on the assessment tool may be considered acceptable risk. The risk score can be a good talking point to emphasize to patients that modifiable risk factors such as obesity or tobacco use significantly increase their infection risk and may be worth addressing prior to considering surgery.

“I think judicious use of the risk scoring tool has the potential to substantially reduce infection rates without changing the treatment plan for most patients presenting for hip or knee arthroplasty. When we look at cases with exceptionally high infection risk, this really represents only a small percentage of patients, even in a university hospital practice that often sees medically complex patients. Among the patients included in our study, if the 3% of patients with the highest scores had been treated non-operatively, there would have been almost a 20% reduction in infection rates.”