The Journal of Bone and Joint Surgery (American). 2006;88:1705-1712.
doi:10.2106/JBJS.E.01156
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Surgical Site Infection in the Elderly Following Orthopaedic Surgery

Risk Factors and Outcomes

Jeanne Lee, MD1, Robert Singletary, MD2, Kenneth Schmader, MD3, Deverick J. Anderson, MD4, Michael Bolognesi, MD5 and Keith S. Kaye, MD, MPH1

1 Duke University Medical Center, Box 3152, Durham, NC 27710. E-mail address for J. Lee: jl55{at}duke.edu. E-mail address for K.S. Kaye: kaye0001{at}mc.duke.edu
2 964 49th Street, Apartment B4, Brooklyn, NY 11219
3 Duke University Medical Center, Box 3469, Durham, NC 27710
4 Duke University Medical Center, Box 3824, Durham, NC 27710
5 Duke University Medical Center, Box 3269, Durham, NC 27710

Investigation performed at the Divisions of Infectious Diseases and Geriatrics, Department of Medicine, the Center for the Study of Aging, and the Department of Surgery, Duke University Medical Center, and Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, North Carolina

In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from the National Institute of Aging (K23 AG23621-01A1), the John A. Hartford Foundation, and the National Institute of Allergy and Infectious Diseases (K24-AI-51324-01). None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Risk factor and outcomes data pertaining to surgical site infection in the elderly following orthopaedic operations are lacking. The aim of this study was to identify risk factors for surgical site infections and to quantify the impact of these infections on health outcomes in elderly patients following orthopaedic surgery.

Methods: A risk factor and outcomes study was performed at Duke University Medical Center, a tertiary care center, and seven community hospitals in North Carolina and Virginia between 1991 and 2002. The study included elderly patients in whom a surgical site infection had developed following orthopaedic surgery and elderly patients in whom a surgical site infection had not developed following orthopaedic surgery (controls). Outcome measures included mortality during the one-year postoperative period and the total length of the hospital stay (including readmissions during the ninety-day postoperative period).

Results: One hundred and sixty-nine patients with a surgical site infection were identified, and 171 controls were selected. The mean age of the patients was 74.7 years. The most frequent procedures were hip arthroplasty (n = 74, 22%) and open reduction of fractures (n = 55, 16%). The most common pathogen was Staphylococcus aureus (n = 95, 56%). A risk factor for surgical site infection, identified in the multivariate analysis, was admission from a health-care facility (odds ratio = 4.35; 95% confidence interval = 1.64, 11.11). Multivariate analysis also indicated that surgical site infection was a strong predictor of mortality (odds ratio = 3.80; 95% confidence interval = 1.49, 9.70) and an increased length of stay in the hospital (multiplicative effect = 2.49; 95% confidence interval = 2.10, 2.94; 9.31 mean attributable days per infection, 95% confidence interval = 6.88, 12.13).

Conclusions: Measures for prevention of surgical site infection in elderly patients should target individuals who reside in health-care facilities prior to surgery. Future studies should be done to examine the effectiveness of such interventions in preventing infection and improving outcomes in elderly patients who undergo orthopaedic surgery.

Level of Evidence: Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.


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