The accuracy of reporting of periprosthetic joint infection to the Australian Orthopaedic Association National Joint Replacement Registry

Abstract

Aims National joint registries under-report revisions for periprosthetic joint infection (PJI). We aimed to validate PJI reporting to the Australian Orthopaedic Association National Joint Arthroplasty Registry (AOANJRR) and the factors associated with its accuracy. We then applied these data to refine estimates of the total national burden of PJI. Methods A total of 561 Australian cases of confirmed PJI were captured by a large, prospective observational study, and matched to data available for the same patients through the AOANJRR. Results In all, 501 (89.3%) cases of PJI recruited to the prospective observational study were successfully matched with the AOANJRR database. Of these, 376 (75.0%) were captured by the registry, while 125 (25.0%) did not have a revision or reoperation for PJI recorded. In a multivariate logistic regression analysis, early (within 30 days of implantation) PJIs were less likely to be reported (adjusted odds ratio (OR) 0.56; 95% confidence interval (CI) 0.34 to 0.93; p = 0.020), while two-stage revision procedures were more likely to be reported as a PJI to the registry (OR 5.3 (95% CI 2.37 to 14.0); p ≤ 0.001) than debridement and implant retention or other surgical procedures. Based on this data, the true estimate of the incidence of PJI in Australia is up to 3,900 cases per year. Conclusion In Australia, infection was not recorded as the indication for revision or reoperation in one-quarter of those with confirmed PJI. This is better than in other registries, but suggests that registry-captured estimates of the total national burden of PJI are underestimated by at least one-third. Inconsistent PJI reporting is multifactorial but could be improved by developing a nested PJI registry embedded within the national arthroplasty registry. Cite this article: Bone Jt Open 2022;3(5):367–373.

Periprosthetic joint infection: what next?

“…1 Although registries under-report infections, PJI is the second most common indication for revision total knee arthroplasty (TKA) (23.5%) and the fourth most common indication for revision total hip arthroplasty (THA) (14.4%) in the UK. 1-4 As the number of arthroplasties which are undertaken increases each year, the incidence and burden of PJI will also increase. 5 The combined annual hospital costs in the USA related to PJI of the hip and knee are estimated to become $1.85 billion by 2030; similarly large costs will be seen worldwide.…”

Antibiotic utilisation in primary and revision total hip replacement patients: A registry linkage cohort study of 106 253 patients using the Australian Orthopaedic Association National Joint Replacement Registry

“…18 A recent data linkage study of an infection database with the AOANJRR found that the registry captured approximately 75% of PJI. 19 While the revision PJI cause may have been underestimated in our study, our approach to separately examining rate and profile of antibiotic prescribing for a revision for other causes (and primary no revision) group provides some assurance that misclassification of the PJI cause is likely marginal. Both the higher prevalence rate (19.2 per 100 persons) and differing profile of post-operative antibiotics in the revision for PJI group when compared with other cohort groupings provide evidence of a distinctly different cohort affected by PJI.…”

“…Another Danish study identified a 40% higher incidence of PJI employing multiple data sources for PJI identification compared with use of DHAR alone 18 . A recent data linkage study of an infection database with the AOANJRR found that the registry captured approximately 75% of PJI 19 …”

Implementing large-scale data quality validation in a national arthroplasty registry to improve compliance

“…The NJR DQA demonstrates that baseline revision compliance has been consistently above 85% since 2014. We also build on work conducted by international registries in Australia, 5 New Zealand, 6 and Sweden, 7 which examined the accuracy of reporting of revision surgery for periprosthetic joint infection and found missingness of between 25% and 33%.…”