Variation in Prosthetic Joint Infection and treatment strategies during 4.5 years of follow-up after primary joint arthroplasty using administrative data of 41397 patients across Australian, European and United States hospitals

BMC Musculoskeletal Disorders

Research Article

Perla J. Marang-van de Mheen¹  Susan Liew²  Rob G. H. H. Nelissen³  Ton Tran⁴  Nora Mutalima⁵  Andrew Gordon⁶  Ellie Bragan Turner⁷  Sten Rasmussen⁸ 

[1] Department of Medical Decision Making, Leiden University Medical Center, PO Box 9600, J10-S, 2300 RC, Leiden, The Netherlands;Department of Orthopaedic Surgery, Alfred Hospital, Melbourne, Australia;Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands;Department of Orthopaedic Surgery, Monash Health, Dandenong, Australia;Department of Orthopaedic Surgery, Monash Health, Dandenong, Australia;Department of Surgery, Monash University, Dandenong, Australia;Department of Orthopaedic Surgery, Sheffield Teaching Hospitals NHS trust, Sheffield, UK;Dr Foster Ltd, London, UK;Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark;Department of Clinical Medicine, Aalborg University, Aalborg, Denmark;

关键词: Periprosthetic Joint Infection;    International variation;    Total joint replacement;    Treatment strategies;   

DOI  :  10.1186/s12891-017-1569-2

 received in 2017-01-10, accepted in 2017-05-11,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundTo identify best practices and quality improvement initiatives, we aimed to assess whether the incidence of Periprosthetic Joint Infection (PJI) and treatment strategies differed across patients treated in Australian, European and United States (US) hospitals.MethodsRoutinely collected administrative data for 41397 patients undergoing a primary total hip or knee arthroplasty between July 2007-December 2010 across 22 hospitals were included. Patients were followed for 2 years looking for PJI occurrence, defined as early (within 4 weeks) and late PJI, and surgical treatment during 2.5 years after PJI diagnosis. Logistic and Poisson regression models were used to test for differences in PJI occurrence and treatment strategies across the three geographical regions, adjusted for age, sex, joint and Elixhauser comorbidity groups.ResultsPJI occurrence varied from 1.4% in European to 1.7% in Australian patients, which were significantly higher than US patients after adjustment for patient characteristics (OR 1.24 [1.01–1.52] and 1.40 [1.03–1.91] respectively). Early PJIs varied between 0.3% in European to 0.6% in Australian patients, but adjusted rates were similar. Revision following PJI was significantly lower in Australian than in US patients (OR 0.46 [0.25–0.86]) as were the total number of revisions (RR 0.51 [0.36–0.71]) and number of surgical procedures (RR 0.60 [0.44–0.81]) used to treat PJI.ConclusionThe overall PJI rate was significantly higher in Australian patients, but fewer procedures were needed to treat these PJIs. Future research should reveal whether this reflects PJIs caught earlier or less severe when diagnosed, and whether this is associated with the longer length of stay after primary arthroplasty in Australian hospitals.

【 授权许可】

CC BY   
© The Author(s). 2017