Postoperative wound infections--systematic recording for seven years at a local hospital

Norwegian law requires all health institutions to have programmes in place for systematic surveillance of infections. Recording of wound infections is mandatory in surgical departments. We here present data from seven years of follow-up at a local hospital. 2,421 patients, who comprised the study population, underwent orthopaedic procedures (acute or elective) from 1.2.1998 through 31.12.2004. Patients with orthopaedic implants were followed up for 12 months after the operation and other patients for four weeks. Quarterly reports were prepared and preventive measures undertaken. One patient was lost to follow-up. 158 infections (mean: 6.5% of the patients, annual variation: 4.8-10.5%) were recorded; 56 of these were deep (2.3% of the patients) and 102 superficial. 28 of the deep infections occurred in primary hip replacement operations. The incidence of infections during three months varied from 1.6% to 8.9%. 72% of the infections were discovered after hospital discharge. Deep hip infections were detected from six days up to 18 months post-operatively. Multivariate analysis showed a positive correlation between surgeon and deep hip infection in primary hip replacement surgery. Systematic recording of post-operative wound infections is a time-consuming, but important quality assurance measure. Recording should be carried out for one year in hip replacement surgery and for at least four weeks after other operations. The incidence of infections varies largely during three months and long-term recording is required to obtain valid data in a single hospital. Deep infections in primary hip replacement surgery may be operator-dependant.