Risk stratification holds the key to identifying those at greatest risk of developing a surgical site infection and then doing something about it, writes Paul Trueman

Paul trueman

Paul Trueman

Paul Trueman

”Prevention is better than cure” – so states the old maxim. In the case of surgical site infections following orthopaedic surgery this is certainly the case.

Public Health England surveillance data suggests that surgical site infections following total joint replacement are relatively rare events, occurring in less than one in 100 procedures.

However, the majority of surveillance data only takes account of infections that are detected during initial hospitalisation or on readmission. Data from patient reported outcome measures following surgery, collected by the Health & Social Care Information Centre between 2010-2011, identified wound complications in around one in 10 patients who had undergone a hip or knee replacement procedure.

The cost factor

From a clinical perspective, it is true to say that prevention is better than cure. However, with heightened financial pressures on the health service, it is also important to consider the economic perspective – is prevention cheaper than cure? Most of the interventions designed to contain the risk of surgical site infection represent a relatively modest sum compared to the costs of managing a deep infection.

Using these data to derive evidence based risk stratification systems can ensure that those patients at greatest risk of developing a surgical site infection can be allocated to more intensive prevention protocols

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The difficulty is how to manage the cost of prevention across a population. The National Joint Registry estimates there are around 160,000 hip and knee joint replacement procedures per year – the addition to each procedure of even a marginal cost for the prevention of surgical site infections would create a significant financial burden to healthcare providers.

One way of addressing this is through risk stratification. Thanks to the early initiation of surgical site infection surveillance in the NHS, there is now a significant body of data that provides insight into risk factors for the development of surgical site infections.  

This data indicates the increased risk of infection following revision procedures in patients with elevated ASA (American Society of Anesthesiologists) scores or with a BMI of greater than 30.

Using these data to derive evidence based risk stratification systems can ensure that those patients at greatest risk of developing a surgical site infection can be allocated to more intensive prevention protocols. This reduces the excess morbidity associated with avoidable infections and also ensures scarce resources are allocated to those most able to benefit. Maybe in this instance prevention can be both better and cheaper than the cure.

Paul Trueman is vice president, market access, Smith & Nephew

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