Advertisement

Infection

, Volume 41, Issue 2, pp 479–483 | Cite as

Is there a benefit to a routine preoperative screening of infectivity for HIV, hepatitis B and C virus before elective orthopaedic operations?

  • P. Weber
  • J. Eberle
  • J. R. Bogner
  • F. Schrimpf
  • V. Jansson
  • S. Huber-Wagner
Clinical and Epidemiological Study

Abstract

Purpose

Before elective operations, particularly orthopaedic surgery, national guidelines in Germany recommend testing for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) to reduce the risk of transmission of the virus through a needlestick or cutting injury. Such testing is expensive. The number of new and unknown diagnoses of viral infections that can be detected by routine screening has not yet been evaluated.

Methods

The aim of our department of orthopaedic surgery is to screen every adult patient listed for an operation for HBV, HCV and HIV. We retrospectively analysed the number of operations in this single centre from 2001 to 2010, correlated this number with the total number of screens and calculated the number of newly diagnosed infections. An additional cost:benefit ratio was calculated.

Results

A total of 20,869 operations were performed by the department between 2001 and 2010. After exclusion of all interventions in children and all patients who had multiple operations, 15,482 patients remained. Test results were found for 10,011 of these patients during this period (screening rate 65 %). Of those screened, in only four cases (0.4 ‰) was a previously unknown infection detected.

Conclusions

Two-thirds of the patients included in our study actually underwent screening; this rate was lower than expected. The incidence of newly detected infections was low, putting the benefit of a routine preoperative screening for HBV, HCV and HIV into question. From an economic point of view the low detection rate is a strong argument in favour of omitting routine preoperative screening. Screening only those patients with risk factors may be as safe as screening every patient and would help reduce costs.

Keywords

Preoperative screening Hepatitis B virus Hepatitis C virus Human immunodeficiency virus Needle stick injury 

Notes

Conflict of interest

JE has Board Membership in MSD Sharp & Dome, provides Expert Testimony for the Prosecutor`s Office and has received payment for lectures, patents and royalties from Siemens Healthcare and Roche Diagnostics. JRB has Board Membership in Abbott, Boerhringer Ingelheim and MSD Sharp & Dome and has received payment for lectures from Abbott, Astellas, Bayer, Boerhringer Ingelheim, Gilead, Jannsen, MSD and Novartis.

References

  1. 1.
    Panlilio AL, Shapiro CN, Schable CA, et al. Serosurvey of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infection among hospital-based surgeons. Serosurvey Study Group. J Am Coll Surg. 1995;180(1):16–24.PubMedGoogle Scholar
  2. 2.
    Tokars JI, Bell DM, Culver DH, et al. Percutaneous injuries during surgical procedures. JAMA. 1992;267(21):2899–904.PubMedCrossRefGoogle Scholar
  3. 3.
    Tokars JI, Marcus R, Culver DH, et al. Surveillance of HIV infection and zidovudine use among health care workers after occupational exposure to HIV-infected blood. The CDC Cooperative Needlestick Surveillance Group. Ann Intern Med. 1993;118(12):913–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Leone S, Gregis G, Quinzan G, et al. Causes of death and risk factors among HIV-infected persons in the HAART era: analysis of a large urban cohort. Infection. 2011;39(1):13–20.PubMedCrossRefGoogle Scholar
  5. 5.
    Panlilio AL, Cardo DM, Grohskopf LA, Heneine W, Ross CS, et al. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep. 2005;54(RR-9):1–17.PubMedGoogle Scholar
  6. 6.
    German Association for Trauma Surgery. Guidelines for “arthroplasty in osteoarthritis of the hip”. AWMF Online May 2008. Available at: http://www.awmf.org/leitlinien/detail/ll/012-006.html.
  7. 7.
    Boy O, Hahn S, Kociemba E. BQS–Fachgruppe Orthopädie und Unfallchirurgie. Hüftgelenknahe Femurfraktur. Düsseldorf: BQS Bundesgeschäftsstelle Qualitätssicherung gGmbH; 2012. p. 138–145.Google Scholar
  8. 8.
    Boy O, Hahn S, Kociemba E. BQS–Fachgruppe Orthopädie und Unfallchirurgie. Hüftprothesenerstimplantation. Düsseldorf: BQS Bundesgeschäftsstelle Qualitätssicherung gGmbH; 2012. p. 146–153.Google Scholar
  9. 9.
    Henderson DK, Fahey BJ, Willy M, et al. Risk for occupational transmission of human immunodeficiency virus type 1 (HIV-1) associated with clinical exposures. A prospective evaluation. Ann Intern Med. 1990;113(10):740–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Marcus R. Surveillance of health care workers exposed to blood from patients infected with the human immunodeficiency virus. N Engl J Med. 1988;319(17):1118–23.PubMedCrossRefGoogle Scholar
  11. 11.
    Wiegand J, Kaiser T, Lobstein S, et al. Low prevalence of chronic hepatitis C, but high prevalence of elevated aminotransferases in a cohort of 2026 patients referred for orthopaedic surgery in the eastern part of Germany. Z Gastroenterol. 2006;44(1):11–4.PubMedCrossRefGoogle Scholar
  12. 12.
    Thierfelder W, Hellenbrand W, Meisel H, Schreier E, Dortschy R. Prevalence of markers for hepatitis A, B and C in the German population. Results of the German National Health Interview and Examination Survey 1998. Eur J Epidemiol. 2001;17(5):429–35.PubMedCrossRefGoogle Scholar
  13. 13.
    Simonian PT, Gilbert M, Trumble TE. Incidence of hepatitis C in patients requiring orthopaedic surgery. J Bone Jt Surg Br. 1995;77(6):971–4.Google Scholar
  14. 14.
    Sanchez LP, Flynn JM, Mayol M. Seroprevalence of blood borne transmissible diseases in trauma orthopaedic surgical patients. P R Health Sci J. 1998;17(2):113–6.PubMedGoogle Scholar
  15. 15.
    Needlestick and HCV. The German Liver Foundation 2012 (in German). Available at: http://www.deutsche-leberstiftung.de/Hilfe/informationen-fuer-aerzte/copy_of_nadelstich-und-hcv. Accessed 20 May 2012.
  16. 16.
    Robert Koch Institute. Recommendations for vaccination against HBV. Robert Koch Institute 2012. Available at: http://www.rkide/cln_160/nn_1270420/SharedDocs/FAQ/Impfen/HepatitisB/FAQ01html2012. Accessed 22 May 2012.
  17. 17.
    Charache P, Cameron JL, Maters AW, Frantz EI. Prevalence of infection with human immunodeficiency virus in elective surgery patients. Ann Surg. 1991;214(5):562–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Lo RV III. Economic analysis of hepatitis B screening and treatment. Clin Infect Dis. 2011;52(11):1307–9.CrossRefGoogle Scholar
  19. 19.
    Weinbaum CM, Williams I, Mast EE, et al. Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm Rep. 2008;57(RR-8):1–20.PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • P. Weber
    • 1
  • J. Eberle
    • 2
  • J. R. Bogner
    • 3
  • F. Schrimpf
    • 1
    • 4
  • V. Jansson
    • 1
  • S. Huber-Wagner
    • 1
    • 4
  1. 1.Department of Orthopedic Surgery, University HospitalLudwig-Maximilians-University (LMU)MunichGermany
  2. 2.Department of Virology, Max von Pettenkofer-InstituteLMU MunichMunichGermany
  3. 3.Department of Infectious Diseases, Med. Klinik und Poliklinik IVUniversity Hospital of MunichMunichGermany
  4. 4.Department of Trauma Surgery, Klinikum rechts der IsarTechnical University MunichMunichGermany

Personalised recommendations