Has the Rate of In-hospital Infections After Total Joint Arthroplasty Decreased?

Abstract

Background Although infections are a major cause of morbidity and mortality after total joint arthroplasty (TJA), little is known about nationwide epidemiology and trends of infections after TJA. Questions/purposes We therefore determined (1) trends of postoperative pneumonia, urinary tract infection (UTI), surgical site infection (SSI), sepsis, and severe sepsis after TJA; (2) risk factors of these infections; (3) effect of these infections on length of stay (LOS) and hospital charges; and (4) the infection-related mortality rate and its predictors. Methods The International Classification of Diseases, 9 th Revision codes were used to identify patients who underwent TJA and were diagnosed with aforementioned infections during hospitalization in the Nationwide Inpatient Sample database from 2002 to 2010. Multivariate analysis was performed to identify risk factors of these infections. Results Rates of pneumonia, UTI, SSI, sepsis, and severe sepsis were 0.74%, 3.26%, 0.31%, 0.25%, and 0.15%, respectively. Number of comorbidities and type of TJA were independent predictors of infection. Mortality decreased during the study period (odds ratio, 0.87; 95% confidence interval, 0.86-0.89). The median LOS was 3 days without complications but increased in the presence of SSI (median, 7 days), sepsis (median, 12 days), and severe sepsis (median, 15 days). Occurrence of pneumonia, sepsis, and severe sepsis increased risk of mortality 5.2, 8.5, and 66.2 times, respectively. Conclusions Rates of UTI, pneumonia, and SSI but not sepsis and severe sepsis are apparently decreasing. The likelihood of infection is increasing with number of comorbidities and revision surgeries. Rate of sepsis-related mortality is also decreasing. Level of Evidence Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

What Is the Timing of General Health Adverse Events That Occur After Total Joint Arthroplasty?

“…This is a particularly important consideration given the increase in the use of inpatient-only data collection programs to study the occurrence of adverse events [2,3,25,27,29]. An example of such a program is the Nationwide Inpatient Sample (NIS), which samples hospitals across the country and captures data regarding procedures and adverse events during the inpatient stay.…”

Who Leaves the Hospital Against Medical Advice in the Orthopaedic Setting?

“…Baseline comorbidity status was assessed using the Elixhauser comorbidity algorithm, which contains 30 comorbidities [12,31,35]. Four conditions included in the Elixhauser algorithm (alcohol abuse, drug abuse, psychosis, and AIDS/HIV infection) were analyzed separately, because they have been previously associated with self-discharge [22,32], thus leaving 26 comorbidities for summation (Table 1).…”

Minorities Are Less Likely to Receive Autologous Blood Transfusion for Major Elective Orthopaedic Surgery

“…Explanatory variables consisted of age (categorized into the age groups: \ 55, 55-74, and C 75 years), sex, comorbidity burden (quantified with the Elixhauser comorbidity score [11,34]), race/ethnicity (white, black, Hispanic, and other), insurance status (private insurance, public insurance, and no insurance), household income based on postal zip code analysis (USD 1 to USD 38,999, USD 39,000 to USD 62,999, and C USD 63,000), surgical procedure (THA, TKA, and spinal fusion), length of hospitalization, discharge disposition (home, home health care, rehabilitation/skilled nursing facility, hospital transfer, and other), hospital location (urban and rural), and hospital teaching status (nonteaching and teaching). Ratios of autologous to allogeneic blood use were calculated for all explanatory variables.…”