In-hospital mortality analysis in patients with proximal femoral fracture operatively treated by hip arthroplasty procedure.

BACKGROUND/AIM: Hip fracture remains the leading cause of death in trauma among elderly population and is a great burden to national health services. In-patient death analysis is important to evaluate risk factors, make appropriate selection and perform adequate treatment of infections for patients to be operated. The aim of this study was to analyze in-hospital mortality in proximal femoral fracture patients operatively treated with hip arthroplasty procedure. METHODS: We followed 622 consecutive patients, and collected data about age, gender, the presence of infection preoperatively and postoperatively, American Society of Anesthesiologists (ASA) score, diabetes mellitus and the type of surgical procedure. Postoperative infections included pneumonia, urinary tract infections, surgical site infections and sepsis. RESULTS: We found a statistically significant influence of preoperative and postoperative infection presence for in-patient mortality with relative risk for lethal outcome of 4.53 (95% CI: 1.44-14.22) for patients with preoperative infection and 7.5 (95% CI: 1.90-29.48) for patients with postoperative infection. We did not confirm a statistically significant influence of age, gender, ASA score, diabetes mellitus or the type of surgical procedure for increased mortality rate. CONCLUSION: Adequate preoperative selection, risk evaluation and adequate treatment of infections are of the key importance for lowering the risk of death in patients operated due to proximal femoral fracture and treated by hip arthroplasty procedures. Special attention is to be paid for the presence of preoperative and postoperative infections in patients operatively treated due to the risk for increased in-hospital mortality.

Severe form of streptococcal necrotizing fasciitis of the upper limb--diagnostic and therapeutic challenge: A case report.

INTRODUCTION: Since delay in recognition and effective treatment of necrotizing fasciitis (NF) caused by invasive group A streptococcus increases the mortality and disability, the early diagnosis and management of this disease are essential for a better outcome. We presented a patient with a severe form of streptococcal NF of the left upper limb in whom amputation was performed as a life saving procedure. CASE REPORT: A 65-year-old man, previously healthy, suffered an injury to his left hand by sting on a fish bone. Two days after that the patient got fever, redness, swelling and pain in his left hand. Clinical examination of the patient after admission indicated NF that spread quickly to the entire left upper limb, left armpit, and the left side of the chest and abdomen. Despite the use of aggressive antibiotic and surgical therapy severe destruction of the skin and subcutaneous tissues developed with the development of gangrene of the left upper limb. In this situation, the team of specialists decided that the patient must be operated on submitted to amputation of the left arm, at the shoulder. After amputation and aggressive debridement of soft tissue on the left side of the trunk, the patient completely recovered. beta-hemolytic streptococcus group A was isolated from the skin and tissue obtained during the surgery. CONCLUSION: In the most severe forms of streptococcal NF of the extremities, adequate multidisciplinary treatment, including limb amputation, can save the life of a patient.

Surgical site infection surveillance in orthopedic patients in the Military Medical Academy, Belgrade.

BACKGROUND/AIM: Active surveillance is an important component of surgical site infection (SSI) reduction strategy. The aim of this study was to analyze and compare SSI surveillance data in orthopedic patients in the Military Medical Academy (MMA), Belgrade. METHODS: A 4-year prospective cohort study was performed to identify the incidence rate and risk factors for SSI in orthopedic patients in the MMA, Belgrade. We collected data regarding patients characteristics, health care and micro-organisms isolated in SSI. The National Nosocomial Infection Surveillance (NNIS) risk index was subsequently calculated for each patient. The Centers for Disease Control and Prevention criteria were used for the diagnosis of SSI. RESULTS: Assessment of 3,867 patients after different orthopedic operations revealed SSI in 109 patients. The overall incidence rate of SSI was 2.8% with the decrease from 4.6% in 2007 to 1.6% in 2010. Using NNIS risk index for surgical procedures there were: 53.7% (2,077) patients with risk 0--the incidence rate of 1.4%; 38.9% (1,506) patients with risk 1--the incidence rate of 3.1%; 7.3% (281) patients with risk 2--the incidence rate of 11.7%; 0.1% (3) patients with risk 3--without infection within the risk. Multivariate logistic regression analysis identified 6 independent risk factors associated with SSI: contaninated or dirty wounds, smoking, preoperative infection, NNIS risk index, body mass index and the length of hospital stay. CONCLUSION: The results of our study are valuable confirmation of relations between risk factors and SSI in orthopedic patients. A decreasing incidence rate of SSI (from 4.6% to 1.6%) during a 4-year active surveillance approved its implementation as an important component of SSI reduction strategy.