Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Oct;471(10):3102-11.
doi: 10.1007/s11999-013-2949-z.

Has the rate of in-hospital infections after total joint arthroplasty decreased?

Mohammad R Rasouli  1 , Mitchell Gil Maltenfort, James J Purtill, William J Hozack, Javad Parvizi
Affiliations

Has the rate of in-hospital infections after total joint arthroplasty decreased?

Mohammad R Rasouli et al. Clin Orthop Relat Res. 2013 Oct.

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, 9th 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.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
The NIS data indicate that all TJAs are being performed in increasing numbers.
Fig. 2A–C
Fig. 2A–C
Nationwide trends of pneumonia (A), UTI (B), and SSI (C) are plotted by type of procedure. Controlling for demographic and clinical factors, these rates all tended to reduce by year.
Fig. 3A–B
Fig. 3A–B
Trends of sepsis (A) and severe sepsis (B) from 2002 to 2010. Rates of any sepsis (severe or not severe) or severe alone increase annually.
Fig. 4A–B
Fig. 4A–B
Comparison of hospitalization charges between patients without any infection and those with UTI or SSI and pneumonia (A) and a similar comparison between patients without sepsis and those with sepsis of any kind or those with specifically severe sepsis (B). Figures demonstrate infections increase hospital charges in patients having TJA.
Fig. 5
Fig. 5
Rate of mortality after TJA decreases per year but is sharply increased by the presence of sepsis.
See this image and copyright information in PMC

References

    1. Adrie C, Azoulay E, Francais A, Clec’h C, Darques L, Schwebel C, Nakache D, Jamali S, Goldgran-Toledano D, Garrouste-Orgeas M, Timsit JF. Influence of gender on the outcome of severe sepsis: a reappraisal. Chest. 2007;132:1786–1793. doi: 10.1378/chest.07-0420. - DOI - PubMed
    1. Angele MK, Schwacha MG, Ayala A, Chaudry IH. Effect of gender and sex hormones on immune responses following shock. Shock. 2000;14:81–90. doi: 10.1097/00024382-200014020-00001. - DOI - PubMed
    1. Barnes CL. Overview: the health care burden and financial costs of surgical site infections. Am J Orthop (Belle Mead NJ). 2011;40:2–5. - PubMed
    1. Bateman BT, Schmidt U, Berman MF, Bittner EA. Temporal trends in the epidemiology of severe postoperative sepsis after elective surgery: a large, nationwide sample. Anesthesiology. 2010;112:917–925. doi: 10.1097/ALN.0b013e3181cea3d0. - DOI - PubMed
    1. Beery TA. Sex differences in infection and sepsis. Crit Care Nurs Clin North Am. 2003;15:55–62. doi: 10.1016/S0899-5885(02)00028-X. - DOI - PubMed

MeSH terms