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Published on: December 3, 2017
Surgical site infection after primary hip and knee arthroplasty: a cohort study using a hospital database
Leslie Grammatico-Guillon1, Sabine Baron2, Philippe Rosset3
11Service d'Information Médicale,d'Epidémiologie et d'Economie de la Santé,Centre Hospitalier Régional Universitaire de Tours,Laboratoire de santé publique,Université François Rabelais,Tours,France.
Background:
Hip or knee arthroplasty infection (HKAI) leads to heavy medical consequences even if rare.
Objective:
To assess the routine use of a hospital discharge detection algorithm of prosthetic joint infection as a novel additional tool for surveillance.
Methods:
A historic 5-year cohort study was built using a hospital database of people undergoing a first hip or knee arthroplasty in 1 French region (2.5 million inhabitants, 39 private and public hospitals): 32,678 patients with arthroplasty code plus corresponding prosthetic material code were tagged. HKAI occurrence was then tracked in the follow-up on the basis of a previously validated algorithm using International Statistical Classification of Disease, Tenth Revision, codes as well as the surgical procedures coded. HKAI density incidence was estimated during the follow-up (up to 4 years after surgery); risk factors were analyzed using Cox regression.
Results:
A total of 604 HKAI patients were identified: 1-year HKAI incidence was1.31%, and density incidence was 2.2/100 person-years in hip and 2.5/100 person-years in knee. HKAI occurred within the first 30 days after surgery for 30% but more than 1 year after replacement for 29%. Patients aged 75 years or older, male, or having liver diseases, alcohol abuse, or ulcer sore had higher risk of infection. The inpatient case fatality in HKAI patients was 11.4%.
Conclusions:
The hospital database method used to measure occurrence and risk factors of prosthetic joint infection helped to survey HKAI and could optimize healthcare delivery.
