Surgical site infections after hip arthroplasty in Norway, 2005-2011: Influence of duration and intensity of postdischarge surveillance

Published:February 08, 2015DOI:


      • 79% of all SSIs and 82% of deep SSIs were detected after hospital discharge.
      • 95% of deep SSIs were detected within 90 days after surgery.
      • All deep SSIs detected beyond 30 days could have been detected by passive PDS.
      • Passive PDS beyond 30 days may replace active PDS without reducing sensitivity.


      Most surgical site infections (SSIs) after hip arthroplasty are detected after a patient is discharged from hospital, making postdischarge surveillance (PDS) an important component in surveillance systems. We investigated how long it was necessary to monitor hip arthroplasty patients for SSIs after hospital discharge and if passive PDS through readmissions could replace active PDS by patient questionnaire in detecting SSIs.


      We used data from the Norwegian surveillance system from 2005-2011, which has active 1-year PDS, to investigate proportions of SSIs found at different time intervals after surgery and whether these SSIs could have been detected through passive PDS by investigating the proportion of patients with SSIs that were readmitted.


      We found that 79% of all SSIs and 82% of deep SSIs were detected after hospital discharge. 95% of deep SSIs were detected within 90 days after surgery. 14% of the deep SSIs were detected beyond 30 days after surgery, and all of these patients were readmitted because of their SSI and thus could have been detected by passive PDS.


      Our data suggest that most deep SSIs are detected within 90 days and that passive PDS beyond 30 days after surgery may replace active PDS without reducing sensitivity.

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        • Gastmeier P.
        Postdischarge surveillance for surgical site infection: the continuing challenge.
        Infect Control Hosp Epidemiol. 2006; 27: 1287-1290
        • Horan T.C.
        • Gaynes R.P.
        • Martone W.J.
        • Jarvis W.R.
        • Emori T.G.
        CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections.
        Infect Control Hosp Epidemiol. 1992; 13: 606-608
        • ECDC
        Surveillance of surgical site infections in European hospitals– HAISSI protocol. Version 102.
        European Centre for Disease Prevention and Control, Stockholm2012
        • Goto M.
        • Ohl M.E.
        • Schweizer M.L.
        • Perencevich E.N.
        Accuracy of Administrative code data for the surveillance of healthcare-associated infections: a systematic review and Meta-Analysis.
        Clin Infect Dis. 2014; 58: 688-696
        • van Mourik M.S.
        • Troelstra A.
        • van Solinge W.W.
        • Moons K.G.
        • Bonten M.J.
        Automated surveillance for healthcare-associated infections: opportunities for improvement.
        Clin Infect Dis. 2013; 57: 85-93
        • Leal J.
        • Laupland K.B.
        Validity of electronic surveillance systems: a systematic review.
        J Hosp Infect. 2008; 69: 220-229
        • Freeman R.
        • Moore L.S.
        • Garcia Alvarez L.
        • Charlett A.
        • Holmes A.
        Advances in electronic surveillance for healthcare-associated infections in the 21st Century: a systematic review.
        J Hosp Infect. 2013; 84: 106-119
      1. Ministry of Health and Care Services, Oslo. Norwegian Surveillance System for Antibiotic Consumption and Healthcare-Associated Infections (NOIS) Act 2005 Available from:∗&&. Accessed January 21, 2015.

        • Løwer H.L.
        • Eriksen H.-M.
        • Aavitsland P.
        • Skjeldestad F.E.
        Methodology of the Norwegian Surveillance System for Healthcare-Associated Infections: the value of a mandatory system, automated data collection, and active postdischarge surveillance.
        Am J Infect Control. 2013; 41: 591-596
        • Dale H.
        • Skramm I.
        • Lower H.L.
        • Eriksen H.M.
        • Espehaug B.
        • Furnes O.
        • et al.
        Infection after primary hip arthroplasty: a comparison of 3 Norwegian health registers.
        Acta Orthop. 2011; 82: 646-654
        • Emori T.G.
        • Culver D.H.
        • Horan T.C.
        • Jarvis W.R.
        • White J.W.
        • Olson D.R.
        • et al.
        National nosocomial infections surveillance system (NNIS): description of surveillance methods.
        Am J Infect Control. 1991; 19: 19-35
        • The NOMESCO
        Classification of Surgical Procedures [Internet].
        Nordic Centre for Classifications in Health Care, 2009 (2009. Available from:) (Accessed January 21, 2015)
        • Urquhart D.M.
        • Hanna F.S.
        • Brennan S.L.
        • Wluka A.E.
        • Leder K.
        • Cameron P.A.
        • et al.
        Incidence and risk factors for deep surgical site infection after primary total hip arthroplasty: a systematic review.
        J Arthroplasty. 2010; 25: 1216-1222.e1-3
        • Huenger F.
        • Schmachtenberg A.
        • Haefner H.
        • Zolldann D.
        • Nowicki K.
        • Wirtz D.C.
        • et al.
        Evaluation of postdischarge surveillance of surgical site infections after total hip and knee arthroplasty.
        Am J Infect Control. 2005; 33: 455-462
        • Mannien J.
        • Wille J.C.
        • Snoeren R.L.
        • van den Hof S.
        Impact of postdischarge surveillance on surgical site infection rates for several surgical procedures: results from the nosocomial surveillance network in The Netherlands.
        Infect Control Hosp Epidemiol. 2006; 27: 809-816
        • Huotari K.
        • Lyytikainen O.
        • Hospital Infection Surveillance Team
        Impact of postdischarge surveillance on the rate of surgical site infection after orthopedic surgery.
        Infect Control Hosp Epidemiol. 2006; 27: 1324-1329
        • Bolon M.K.
        • Hooper D.
        • Stevenson K.B.
        • Greenbaum M.
        • Olsen M.A.
        • Herwaldt L.
        • et al.
        Improved surveillance for surgical site infections after orthopedic implantation procedures: extending applications for automated data.
        Clin Infect Dis. 2009; 48: 1223-1229
        • Lankiewicz J.D.
        • Yokoe D.S.
        • Olsen M.A.
        • Onufrak F.
        • Fraser V.J.
        • Stevenson K.
        • et al.
        Beyond 30 days: does limiting the duration of surgical site infection follow-up limit detection?.
        Infect Control Hosp Epidemiol. 2012; 33: 202-204
        • Yokoe D.S.
        • Avery T.R.
        • Platt R.
        • Huang S.S.
        Reporting surgical site infections following total hip and knee arthroplasty: impact of limiting surveillance to the operative hospital.
        Clin Infect Dis. 2013; 57: 1282-1288
      2. SAMDATA Spesialisthelsetjenesten 2012. Oslo, Norway: The Norwegian Directorate of Health, 2012 978-82-8081-287-2. Available from: Accessed January 21, 2015.

        • Manian F.A.
        • Meyer L.
        Adjunctive use of monthly physician questionnaires for surveillance of surgical site infections after hospital discharge and in ambulatory surgical patients: report of a seven-year experience.
        Am J Infect Control. 1997; 25: 390-394
        • Trick W.E.
        Decision making during healthcare-associated infection surveillance: a rationale for automation.
        Clin Infect Dis. 2013; 57: 434-440
        • FitzHenry F.
        • Murff H.J.
        • Matheny M.E.
        • Gentry N.
        • Fielstein E.M.
        • Brown S.H.
        • et al.
        Exploring the frontier of electronic health record surveillance: the case of postoperative complications.
        Med Care. 2013; 51: 509-516
        • Calderwood M.S.
        • Ma A.
        • Khan Y.M.
        • Olsen M.A.
        • Bratzler D.W.
        • Yokoe D.S.
        • et al.
        Use of Medicare diagnosis and procedure codes to improve detection of surgical site infections following hip arthroplasty, knee arthroplasty, and vascular surgery.
        Infect Control Hosp Epidemiol. 2012; 33: 40-49
        • Inacio M.C.
        • Paxton E.W.
        • Chen Y.
        • Harris J.
        • Eck E.
        • Barnes S.
        • et al.
        Leveraging electronic medical records for surveillance of surgical site infection in a total joint replacement population.
        Infect Control Hosp Epidemiol. 2011; 32: 351-359
        • Klompas M.
        • Yokoe D.S.
        Automated surveillance of health care-associated infections.
        Clin Infect Dis. 2009; 48: 1268-1275
        • Leaper D.
        • Tanner J.
        • Kiernan M.
        Surveillance of surgical site infection: more accurate definitions and intensive recording needed.
        J Hosp Infect. 2013; 83: 83-86
        • Phillips J.E.
        • Crane T.P.
        • Noy M.
        • Elliott T.S.
        • Grimer R.J.
        The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey.
        J Bone Joint Surg Br. 2006; 88: 943-948
        • Ong K.L.
        • Kurtz S.M.
        • Lau E.
        • Bozic K.J.
        • Berry D.J.
        • Parvizi J.
        Prosthetic joint infection risk after total hip arthroplasty in the Medicare population.
        J Arthroplasty. 2009; 24: 105-109