{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T11:43:01Z","timestamp":1792755781368,"version":"4.5.0"},"reference-count":40,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2022,9,15]],"date-time":"2022-09-15T00:00:00Z","timestamp":1663200000000},"content-version":"unspecified","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Superficial surgical site infection (SSSI) may increase the risk of serious complications such as periprosthetic joint infection (PJI). This study aims to identify patient-related risk factors associated with SSSI and investigate their correlation with the progression of PJI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>In this retrospective study, 1191 elective hip and knee prostheses were included. Patients were interviewed 3\u20135 months after surgery to answer questions about the postoperative period. Patient records were reviewed to determine whether there had been any documentation of wound-healing difficulties or whether antibiotics were prescribed to treat an infection related to arthroplasty surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Uppsala University Hospital, patients treated between November 2008 and December 2012.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The study population comprised 433 knees and 758 hips.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>We studied patient-related risk factors (joint, age, sex, the American Society of Anesthesiologists (ASA) classification, body mass index (BMI), smoking, diabetes and rheumatic disease) to determine whether they were associated with (1) SSSI and (2) the progress from SSSI to PJI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>84 (7%) patients of the total cohort developed SSSI. This infection progressed to a PJI in 24 (29%) of the patients. Factors with increased adjusted risk ratios (aRRs) for SSSIs were knee surgery (1.7; 95% CI: 1.1 to 2.7), age\u226565 years (1.7; 95%\u2009CI: 1.1 to 2.8), BMI\u226530 (1.9; 95%\u2009CI: 1.0 to 3.4) and ASA classification\u22653 (1.7; 95%\u2009CI: 1.0 to 2.9). ASA classification\u22653 was the only factor showing a significant progression from SSSI to PJI (aRR=3.3; 95%\u2009CI: 1.0 to 10.3).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The risk of progressing from an SSSI to a PJI is high. Older patients, patients with obesity, and those with a high ASA classification considered for elective total knee arthroplasty seem to have an increased risk of developing SSSI. Patients with a high ASA classification seem to have an increased risk of progressing from SSSI to PJI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-060754","type":"journal-article","created":{"date-parts":[[2022,9,19]],"date-time":"2022-09-19T13:07:24Z","timestamp":1663592844000},"page":"e060754","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["Patient-related factors associated with superficial surgical site infection and progression to a periprosthetic joint infection after elective primary total joint arthroplasty: a single-centre, retrospective study in Sweden"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9990-8275","authenticated-orcid":false,"given":"Hannah K","family":"Eriksson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stergios","family":"Lazarinis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,9,19]]},"reference":[{"key":"2022091910051776000_12.9.e060754.1","doi-asserted-by":"publisher","DOI":"10.1111\/1469-0691.12209"},{"key":"2022091910051776000_12.9.e060754.2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200111000-00003"},{"key":"2022091910051776000_12.9.e060754.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0736-0266(01)00153-X"},{"key":"2022091910051776000_12.9.e060754.4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2013\/542796","article-title":"Periprosthetic joint infections","volume":"2013","author":"Lima","year":"2013","journal-title":"Interdiscip Perspect Infect Dis"},{"key":"2022091910051776000_12.9.e060754.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2009.08.011"},{"key":"2022091910051776000_12.9.e060754.6","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.87B6.15121"},{"key":"2022091910051776000_12.9.e060754.7","unstructured":"Cooper K , Lamagni T , Harrington P , et al . Surveillance of surgical site infections in NHS hospitals in England, April 2018 to March 2019. Available: www.gov.uk\/phe"},{"key":"2022091910051776000_12.9.e060754.8","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.88B7.17150"},{"key":"2022091910051776000_12.9.e060754.9","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-008-0209-4"},{"key":"2022091910051776000_12.9.e060754.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2008.10.013"},{"key":"2022091910051776000_12.9.e060754.11","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2012.733918"},{"key":"2022091910051776000_12.9.e060754.12","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12640"},{"key":"2022091910051776000_12.9.e060754.13","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0150866"},{"key":"2022091910051776000_12.9.e060754.14","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-014-3780-x"},{"key":"2022091910051776000_12.9.e060754.15","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-013-2923-9"},{"key":"2022091910051776000_12.9.e060754.16","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20036"},{"key":"2022091910051776000_12.9.e060754.17","unstructured":"Swedish association of local authorities and regions, 2020. Available: www.skr.se [Accessed cited 15 May 2020]."},{"key":"2022091910051776000_12.9.e060754.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2018.02.078"},{"key":"2022091910051776000_12.9.e060754.19","doi-asserted-by":"crossref","first-page":"8-43","DOI":"10.1007\/s00167-018-5231-9","article-title":"Higher age, female gender, osteoarthritis and blood transfusion protect against periprosthetic joint infection in total hip or knee arthroplasties: a systematic review and meta-analysis","volume":"29","author":"Resende","year":"2021","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"2022091910051776000_12.9.e060754.20","doi-asserted-by":"crossref","first-page":"1964","DOI":"10.1007\/s11999.0000000000000141","article-title":"Weighing in on body mass index and infection after total joint arthroplasty: is there evidence for a body mass index threshold?","volume":"476","author":"Shohat","year":"2018","journal-title":"Clin Orthop Relat Res"},{"key":"2022091910051776000_12.9.e060754.21","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1080\/17453674.2019.1594015","article-title":"Body mass index is associated with risk of reoperation and revision after primary total hip arthroplasty: a study of the Swedish hip arthroplasty register including 83,146 patients","volume":"90","author":"Sayed-Noor","year":"2019","journal-title":"Acta Orthop"},{"key":"2022091910051776000_12.9.e060754.22","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-9-88"},{"key":"2022091910051776000_12.9.e060754.23","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-007-0016-3"},{"key":"2022091910051776000_12.9.e060754.24","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.00163"},{"key":"2022091910051776000_12.9.e060754.25","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-22-03-193"},{"key":"2022091910051776000_12.9.e060754.26","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1080\/17434440.2020.1720509","article-title":"How viable is pre-surgery weight reduction for the reduction of periprosthetic joint infection risk after total joint arthroplasty?","volume":"17","author":"Yayac","year":"2020","journal-title":"Expert Rev Med Devices"},{"key":"2022091910051776000_12.9.e060754.27","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-015-4333-7"},{"key":"2022091910051776000_12.9.e060754.28","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.jse.2015.07.034","article-title":"Malnutrition: a marker for increased complications, mortality, and length of stay after total shoulder arthroplasty","volume":"25","author":"Garcia","year":"2016","journal-title":"J Shoulder Elbow Surg"},{"key":"2022091910051776000_12.9.e060754.29","doi-asserted-by":"crossref","first-page":"2415","DOI":"10.1016\/j.arth.2016.04.032","article-title":"Malnutrition increases with obesity and is a stronger independent risk factor for postoperative complications: a Propensity-Adjusted analysis of total hip arthroplasty patients","volume":"31","author":"Fu","year":"2016","journal-title":"J Arthroplasty"},{"key":"2022091910051776000_12.9.e060754.30","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.arth.2015.08.028","article-title":"Hypoalbuminemia independently predicts surgical site infection, pneumonia, length of stay, and readmission after total joint arthroplasty","volume":"31","author":"Bohl","year":"2016","journal-title":"J Arthroplasty"},{"key":"2022091910051776000_12.9.e060754.31","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s00402-019-03304-6","article-title":"Risk factors for periprosthetic joint infection after total knee arthroplasty","volume":"140","author":"Blanco","year":"2020","journal-title":"Arch Orthop Trauma Surg"},{"key":"2022091910051776000_12.9.e060754.32","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1080\/17453674.2021.1944529","article-title":"Risk factors for prosthetic joint infections following total hip arthroplasty based on 33,337 hips in the Finnish arthroplasty register from 2014 to 2018","volume":"92","author":"Panula","year":"2021","journal-title":"Acta Orthop"},{"key":"2022091910051776000_12.9.e060754.33","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1007\/s00005-011-0124-3","article-title":"Gender specific differences in the immune response to infection","volume":"59","author":"McClelland","year":"2011","journal-title":"Arch Immunol Ther Exp"},{"key":"2022091910051776000_12.9.e060754.34","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.arth.2014.08.019","article-title":"Long term follow-up of successfully treated superficial wound infections following TKA","volume":"30","author":"Guirro","year":"2015","journal-title":"J Arthroplasty"},{"key":"2022091910051776000_12.9.e060754.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2010.03.017"},{"key":"2022091910051776000_12.9.e060754.36","doi-asserted-by":"crossref","unstructured":"Kurtz SM , Lau EC , Ong KL , et al . Which clinical and patient factors influence the National economic burden of hospital readmissions after total joint arthroplasty? Clin Orthop Relat Res 2017.","DOI":"10.1007\/s11999-017-5244-6"},{"key":"2022091910051776000_12.9.e060754.37","doi-asserted-by":"crossref","first-page":"1861","DOI":"10.1016\/j.arth.2018.01.037","article-title":"Risk factors for surgical site infection following lower limb arthroplasty: a retrospective cohort analysis of 3932 lower limb arthroplasty procedures in a high volume arthroplasty unit","volume":"33","author":"Almustafa","year":"2018","journal-title":"J Arthroplasty"},{"key":"2022091910051776000_12.9.e060754.38","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.G.01686"},{"key":"2022091910051776000_12.9.e060754.39","unstructured":"K\u00e4rrholm J , Rogmark C , Naucl\u00e9r E , et al . Swedish hip arthroplasty register. annual report, 2018. Available: www.shpr.se"},{"key":"2022091910051776000_12.9.e060754.40","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s10096-021-04352-w","article-title":"Heterogeneity of Staphylococcus epidermidis in prosthetic joint infections: time to reevaluate microbiological criteria?","volume":"41","author":"Widerstr\u00f6m","year":"2022","journal-title":"Eur J Clin Microbiol Infect Dis"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-060754","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,19]],"date-time":"2022-09-19T13:07:42Z","timestamp":1663592862000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-060754"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9]]},"references-count":40,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9,19]]},"published-print":{"date-parts":[[2022,9]]}},"alternative-id":["10.1136\/bmjopen-2022-060754"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-060754","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9]]}}}