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A study of self-reported surgical site infection post total hip or total knee replacement

Student thesis: Doctoral Thesis

Background:
Currently there is little published evidence exploring the experience of post discharge surgical patients who have developed infection following hip and knee joint surgery. This mixed methods study used both quantitative (Phase One) and qualitative (Phase Two)methodologies to explore the experience of patients with self-reported surgical site infection

Methods:
Phase One - Used a researcher developed postal questionnaire to identify the incidence of self-reported surgical site infection at six weeks post surgery as well as investigating the patients' experience of diagnosis, treatment and outcome following surgical site infection.
Phase Two - Recruited from Phase One, twenty three patients were recruited from Phase One and invited to participate in one to one unstructured, audio taped qualitative interviews. Guided by Husserlian phenomenological approach to data collection and analysis informed by Colaizzi's method of data analysis, nine patients shared their lived experience of developing an infection post surgery.

Findings:
Phase One - A total of 523 patients were identified at one NHS trust and after exclusions questionnaires and stamped addressed envelopes were posted 505 patients six weeks following either total hip or total knee replacement surgery. A response rate 88.5% led to a final analysis of 447 questionnaires to reveal that 23 (or 5.1%)patients developed a surgical site infection, 7 in total hip replacement and 16 in total knee replacement patients. Ten infections were identified prior to discharge and 13 post discharge. Only 6 of the 23 patients were first seen by a hospital practitioner after suspecting a surgical site infection. 4 patients sought review by their general practitioner, who then referred them on to a hospital practitioner. The remaining 13 patients utilised a combination of different management pathways.
In Phase Two analysis of the nine verbatim transcriptions revealed 5 main themes of (1) Vulnerability, (2) Perception of infection, (3) Significant event, (4) Yo yoing and (5) Pendulum of care.

Dicussion:
Comparisons between current surveillance methods and those utilised in the study identified that current surveillance methods are likely to under represent the total number of self-reported surgical site infections that develop within the six week post operative period. It appears that patients with a surgical site infection experience a number of different management pathways that do not always reflect recommended guidelines. In addition, together the five themes highlight the distress and powerlessness that patients can experience on a journey of surgical site infection within the delivery of current local NHS infection management pathways.
Original languageEnglish
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Award dateSep 2012
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