Protheseninfektionen und die zunehmende Bedeutung psychologischer Komorbiditäten

Walter, Nike; Rupp, Markus; Hinterberger, Thilo; Alt, Volker

doi:10.1007/s00132-021-04088-7

Cited by 11 publications

(6 citation statements)

References 33 publications

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“…Likewise, septic revisions due to PJI increased by over 50% within the last decade [ 6 , 7 ]. Similarly, an incidence of PJI between 23.5 and 27.8 per 100,000 inhabitants in Germany was detected and showed constant growth [ 8 ]. Both types of infection require long and intense therapy, usually a combination of multiple revision surgeries and long-term antibiotic therapy [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Comorbidities as Risk Factors for Fracture-Related Infection and Periprosthetic Joint Infection in Germany

Szymski

Walter

Alt

et al. 2022

JCM

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Introduction: Fracture-related infections (FRI) and periprosthetic joint infections (PJI) represent a major challenge in orthopedic surgery. Incidence of both entities is annually growing. Comorbidities play an important role as an influencing factor for infection and thus, for prevention and treatment strategies. The aims of this study were (1) to analyze the frequency of comorbidities in FRI and PJI patients and (2) to evaluate comorbidities as causative risk factor for PJI and FRI. Methods: This retrospective cohort study analysed all ICD-10 codes, which were coded as secondary diagnosis in all in hospital-treated FRI and PJI in the year 2019 in Germany provided by the Federal Statistical Office of Germany (Destatis). Prevalence of comorbidities was compared with the prevalence in the general population. Results: In the year 2019, 7158 FRIs and 16,174 PJIs were registered in Germany, with 68,304 comorbidities in FRI (mean: 9.5 per case) and 188,684 in PJI (mean: 11.7 per case). Major localization for FRI were infections in the lower leg (55.4%) and forearm (9.2%), while PJI were located mostly at hip (47.4%) and knee joints (45.5%). Mainly arterial hypertension (FRI: n = 3645; 50.9%—PJI: n = 11360; 70.2%), diabetes mellitus type II (FRI: n = 1483; 20.7%—PJI: n = 3999; 24.7%), obesity (FRI: n = 749; 10.5%—PJI: n = 3434; 21.2%) and chronic kidney failure (FRI: n = 877; 12.3%—PJI: n = 3341; 20.7%) were documented. Compared with the general population, an increased risk for PJI and FRI was reported in patients with diabetes mellitus (PJI: 2.988; FRI: 2.339), arterial hypertension (PJI: 5.059; FRI: 2.116) and heart failure (PJI: 6.513; FRI: 3.801). Conclusion: Patients with endocrinological and cardiovascular diseases, in particular associated with the metabolic syndrome, demonstrate an increased risk for orthopedic implant related infections. Based on the present results, further infection prevention and treatment strategies should be evaluated.

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Section: Introductionmentioning

confidence: 99%

Evaluation of Comorbidities as Risk Factors for Fracture-Related Infection and Periprosthetic Joint Infection in Germany

Szymski

Walter

Alt

et al. 2022

JCM

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“… 37 Recently, also raising numbers of psychological comorbidities over the years have been shown for PJI patients, whereby the authors concluded that interdisciplinary collaboration is warranted and a psychologists should be included in the management. 11 In light of the presented findings, routine geriatric screening assessment should be considered. Further, the high number of geriatric infection patients (72.2%) emphasizes that geriatric physicians should be included as part of the PJI treatment team.…”

Section: Discussionmentioning

confidence: 88%

“… 10 Periprosthetic joint infection (PJI) is a dreaded complication in orthopaedics and trauma surgery with an incidence of 24/1 000 000 inhabitants in Germany. 11 Hence, an increasing percentage of older patients with bone and joint infection is expectable.…”

Section: Introductionmentioning

confidence: 99%

The Definition of the Term “Orthogeriatric Infection” for Periprosthetic Joint Infections

Walter

Rupp

Bärtl

et al. 2022

Geriatr Orthop Surg Rehabil

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Introduction In the background of the aging population, an increase of geriatric patients with specific age-related co-morbidities has already been seen over the years for proximal femur fractures in orthopaedic surgery as well as other medical disciplines. However, the geriatric aspect has not been well recognized in periprosthetic joint infection (PJI) patients so far. Therefore, this paper seeks to provide an overview on the co-morbidities of PJI patients with respect to the definition of geriatric patients. Material and methods In this single-center retrospective study, patients treated between 2007 and 2020 for PJI were included (n = 255). Patients were defined as geriatric according to the consensus definition criteria of the Federal Working Group of Clinical Geriatric Facilities e.V., the German Society for Geriatrics e.V. and the German Society for Gerontology and Geriatrics e.V. based on age (≤70 years), geriatric multimorbidity and the Barthel index (≤30). Results Applying the criteria defined 184 of the 255 (72.2%) PJI patients as geriatric infection patients. Regarding geriatric comorbidity, incontinence was most prevalent (38.1%), followed by immobility (25.6%). Comparing the geriatric infection patients with those classified as non-geriatric (n = 71) revealed that geriatric patients had a longer hospital stay and spent more days in the intensive care unit (ICU). Also, the amputation rate and the 5-year mortality rate was significantly increased (n = 15, 8.2% vs n = 1, 1.4%, P = .007 and n = 24, 13.0% vs n = 5, 7.0%, P = .005). The Barthel index showed a significant correlation with mortality ( r = −.22, P = .011). Discussion We propose to use the term orthogeriatric infection patients in those cases in order to focus treatment not only on the orthopaedic infections but also on the important geriatric aspects. Conclusion The inclusion of geriatric physicians into the multidisciplinary team approach for PJI patients might be beneficial.

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“…[13][14][15] According to the recent literature, the overall mortality rate of patients suffering from PJI is 3.2 to 3.7 times higher than of those without joint infection. 3,16 A database search revealed a one-year mortality rate of 4.22% after PJI of the hip and a five-year mortality as high as 21%. 17 A recent study showed that patients with PJI have an even higher risk for in-hospital mortality than those having interventional coronary procedures, cholecystectomy, kidney transplant, or carotid surgery.…”

Section: Introductionmentioning

confidence: 99%

In-hospital mortality of patients with periprosthetic joint infection

Reinhard,

Lang,

Walter

et al. 2024

Bone Jt Open

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AimsPeriprosthetic joint infection (PJI) demonstrates the most feared complication after total joint replacement (TJR). The current work analyzes the demographic, comorbidity, and complication profiles of all patients who had in-hospital treatment due to PJI. Furthermore, it aims to evaluate the in-hospital mortality of patients with PJI and analyze possible risk factors in terms of secondary diagnosis, diagnostic procedures, and complications.MethodsIn a retrospective, cross-sectional study design, we gathered all patients with PJI (International Classification of Diseases (ICD)-10 code: T84.5) and resulting in-hospital treatment in Germany between 1 January 2019 and 31 December 2022. Data were provided by the Institute for the Hospital Remuneration System in Germany. Demographic data, in-hospital deaths, need for intensive care therapy, secondary diagnosis, complications, and use of diagnostic instruments were assessed. Odds ratios (ORs) with 95% confidence intervals (CIs) for in-hospital mortality were calculated.ResultsA total of 52,286 patients were included, of whom 1,804 (3.5%) died. Hypertension, diabetes mellitus, and obesity, the most frequent comorbidities, were not associated with higher in-hospital mortality. Cardiac diseases as atrial fibrillation, cardiac pacemaker, or three-vessel coronary heart disease showed the highest risk for in-hospital mortality. Postoperative anaemia occurred in two-thirds of patients and showed an increased in-hospital mortality (OR 1.72; p < 0.001). Severe complications, such as organ failure, systemic inflammatory response syndrome (SIRS), or septic shock syndrome showed by far the highest association with in-hospital mortality (OR 39.20; 95% CI 33.07 to 46.46; p < 0.001).ConclusionThese findings highlight the menace coming from PJI. It can culminate in multi-organ failure, SIRS, or septic shock syndrome, along with very high rates of in-hospital mortality, thereby highlighting the vulnerability of these patients. Particular attention should be paid to patients with cardiac comorbidities such as atrial fibrillation or three-vessel coronary heart disease. Risk factors should be optimized preoperatively, anticoagulant therapy stopped and restarted on time, and sufficient patient blood management should be emphasized.Cite this article: Bone Jt Open 2024;5(4):367–373.

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Protheseninfektionen und die zunehmende Bedeutung psychologischer Komorbiditäten

Cited by 11 publications

References 33 publications

Evaluation of Comorbidities as Risk Factors for Fracture-Related Infection and Periprosthetic Joint Infection in Germany

Evaluation of Comorbidities as Risk Factors for Fracture-Related Infection and Periprosthetic Joint Infection in Germany

The Definition of the Term “Orthogeriatric Infection” for Periprosthetic Joint Infections

In-hospital mortality of patients with periprosthetic joint infection

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