Infection rates following hip and knee joint arthroplasty: large referral centre versus a small elective-only hospital

Asaid, Rafik; Williams, Isabella; Hyde, D.; Tiang, Thomas

doi:10.1007/s00590-012-0937-8

Cited by 9 publications

(7 citation statements)

References 4 publications

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“…First, this study focused on deep infections that warranted revision surgery, and less serious infections were not evaluated [ 24 ]. Second, the hospital at which the current study was conducted only performs elective THA surgery, and the risk factors for post-THA infection identified in this study may differ from those in departments performing emergency surgeries [ 25 ]. Lastly, since fast-track THA protocols consist of different types and combinations of interventions that can vary by hospital, our findings cannot be generalized to fast-track THA in general and need to be interpreted in light of the specific procedures used in this study.…”

Section: Discussionmentioning

confidence: 99%

A Trend for Increased Risk of Revision Surgery due to Deep Infection following Fast-Track Hip Arthroplasty

Amlie

Lerdal

Høvik

et al. 2016

Advances in Orthopedics

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Rates of revision surgery due to deep infection following total hip arthroplasty (THA) increased at a Norwegian hospital following implementation of fast-track procedures. The purpose of this study was to determine whether selected demographic (age and sex) and clinical (body mass index, American Society of Anesthesiologists (ASA) classification, surgery duration, length of hospital stay, cemented versus uncemented prosthesis, and fast-track procedures) factors were associated with higher risk of revision surgery due to deep infection following THA. In a prospective designed study 4,406 patients undergoing primary THA between January 2001 and January 2013 where included. Rates of infection-related revision surgery within 3 months of THA were higher among males and among patients who received fast-track THA. Adjusting for sex and age, the implemented fast-track elements were significantly associated with increased risk of revision surgery. Risk of infection-related revision surgery was unrelated to body mass index, physical status, surgery duration, length of hospital stay, and prosthesis type. Because local infiltration analgesia, drain cessation, and early mobilization were introduced in combination, it could not be determined which component or combination of components imposed the increased risk. The findings in this small sample raise concern about fast-track THA but require replication in other samples.

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Section: Discussionmentioning

confidence: 99%

A Trend for Increased Risk of Revision Surgery due to Deep Infection following Fast-Track Hip Arthroplasty

Amlie

Lerdal

Høvik

et al. 2016

Advances in Orthopedics

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“…However, Other studies demonstrated that there was no association between previous steroid injections and infection after subsequent joint arthroplasty [ 16 , 21 , 23 ]. Because infection rate of joint arthroplasty is an infrequent event [ 27 ], the failure of some studies that demonstrate such association may be related to the small number of patients included and hence low statistical power.…”

Section: Discussionmentioning

confidence: 99%

Dose intraarticular steroid injection increase the rate of infection in subsequent arthroplasty: grading the evidence through a meta-analysis

Xing

Yang

et al. 2014

J Orthop Surg Res

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BackgroundIntraarticular steroid injections are widely used in joint arthritis. However, the data regarding an association between an increased risk for arthroplasty infection after an intraarticular steroid injection are still conflicting. We conducted a meta-analysis to evaluate the evidence from relevant studies that examine the relation between intraarticular steroid injections and infection rates in subsequent joint arthroplasty and to develop GRADE based recommendations for using the steroid before arthroplasty.MethodsA systematic search of all studies published through August 2014 was conducted using the MEDLINE, EMBASE, OVID, ScienceDirect and Cochrane CENTRAL databases. The relevant studies that examined the relation between intraarticular steroid injections and infection rates in subsequent joint arthroplasty were identified. Demographic characteristics, infection rates and clinical outcomes were manually extracted from all of the selected studies. The evidence quality levels and recommendations were assessed using the GRADE system.ResultsEight studies looking at hip and knee arthroplasties were included. Meta-analysis showed that patients with steroid injection before arthroplasty had a higher deep infection rate than patients without steroid injection (OR = 2.13, 95% CI 1.02-4.45), but no significant effect on superficial infection rate (OR = 1.75, 95% CI 0.74-4.16). The overall GRADE system evidence quality was very low, which lowers our confidence in their recommendations.ConclusionsIntraarticular steroid injections may lead to increased deep infection rates of subsequent joint arthroplasty but not the superficial infection rates. Due to the poor quality of the evidence currently available, further studies are still required.

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“…From the 20 studies reporting complication rates, the between-hospital variation was reported in 11 studies (5 MQ, 6 LQ) for THA (9,10,21,27,41,42,43,44,45,46,47), 8 studies (4 MQ, 4 LQ) for TKA (10,21,33,44,45,46,47,48) and 8 studies (1 HQ, 3 MQ, 4 LQ) for THA and TKA combined (14,15,16,32,38,47,49,50). Eight studies reported the variation more than once with different outcome definition, follow-up, and type of hospitals selected (Table 5).…”

Section: Complicationsmentioning

confidence: 99%

“…mellitus (21), surgical time (21), work relative value unit (21), emergency surgery (21), patient comorbidities (16,28,38), Elixhauser comorbidities ( 9) procedure (THA/ TKA) (16), demographics (39), healthcare use (39), comorbidities selected by veteran affair surgical quality improvement programme (VASQIP) nurses (39), and clinical comorbidity (15). For complications, between-hospital variations were case-mix-adjusted for age (9,10,14,15,16,21,27,41,42,48,50), gender (9,10,14,15,21,27,41,42,48,50), ethnicity (21,41,42), Elixhauser comorbidities (9,41,48), patient comorbidities (14,16,27,38,42), ASA score (10,21), procedure (THA or TKA...…”

Section: :4 P Van Schie and Others 255mentioning

confidence: 99%

International comparison of variation in performance between hospitals for THA and TKA: Is it even possible? A systematic review including 33 studies and 8 arthroplasty register reports

et al. 2022

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In order to improve care for total hip and knee arthroplasties (THA/TKA), hospitals may want to compare their performance with hospitals in other countries. Pooling data across countries also enable early detection of infrequently occurring safety issues. We therefore aimed to assess the between-hospital variation and definitions used for revision, readmission, and complications across countries. PubMed, Embase, Web of Science, Cochrane library, Emcare, and Academic Search Premier were searched from January 2009 to August 2020 for studies reporting on: (i) primary THA/TKA; (ii) revision, readmission, or complications; and (iii) between-hospital variation. Most recent registry reports of Network of Orthopedic Registries of Europe members were also reviewed. Two reviewers independently screened records, extracted data, and assessed the risk of bias using the Integrated quality Criteria for the Review Of Multiple Study designs tool for studies and relevant domains for registries. We assessed agreement for the following domains: (i) outcome definition; (ii) follow-up and starting point; (iii) case-mix adjustment; and (iv) type of patients and hospitals included. Between-hospital variation was reported in 33 (1 high-quality, 13 moderate-quality, and 19 low-quality) studies and 8 registry reports. The range of variation for revision was 0–33% for THA and 0–27% for TKA varying between assessment within hospital admission until 10 years of follow-up; for readmission, 0–40% and 0–32% for THA and TKA, respectively; and for complications, 0–75% and 0–50% for THA and TKA, respectively. Indicator definitions and methodological variables varied considerably across domains. The large heterogeneity in definitions and methods used likely explains the considerable variation in between-hospital variation reported for revision, readmission, and complications , making it impossible to benchmark hospitals across countries or pool data for earlier detection of safety issues. It is necessary to collaborate internationally and strive for more uniformity in indicator definitions and methods in order to achieve reliable international benchmarking in the future.

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Infection rates following hip and knee joint arthroplasty: large referral centre versus a small elective-only hospital

Abstract: Level-two cohort study.

Cited by 9 publications

References 4 publications

A Trend for Increased Risk of Revision Surgery due to Deep Infection following Fast-Track Hip Arthroplasty

A Trend for Increased Risk of Revision Surgery due to Deep Infection following Fast-Track Hip Arthroplasty

Dose intraarticular steroid injection increase the rate of infection in subsequent arthroplasty: grading the evidence through a meta-analysis

International comparison of variation in performance between hospitals for THA and TKA: Is it even possible? A systematic review including 33 studies and 8 arthroplasty register reports

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