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Poor outcome of octogenarians admitted to ICU due to periprosthetic joint infections: a retrospective cohort study
Emre Yilmaz1, Alexandra Poell2, Hinnerk Baecker2
1Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany. emre.yilmaz@gmx.de.
Insights
Periprosthetic joint infection (PJI) in very elderly patients admitted to the ICU carries a high mortality risk. Factors like chronic infection, high comorbidity scores, and need for ventilation or renal replacement therapy (RRT) predict poor outcomes.
Area of Science:
- Orthopedic Surgery
- Critical Care Medicine
- Geriatric Medicine
Background:
- Periprosthetic joint infection (PJI) is a severe complication after joint replacement surgery.
- Mortality data for very elderly patients (80+) with PJI requiring intensive care unit (ICU) admission is scarce.
- This study addresses the lack of data on outcomes for this specific high-risk demographic.
Purpose of the Study:
- To analyze the mortality and risk factors associated with PJI in patients aged 80 and above requiring ICU admission.
- To identify predictors of poor outcomes in this vulnerable patient population.
Main Methods:
- Retrospective, observational, single-center study.
- Inclusion criteria: patients aged 80+ with PJI (acute or chronic) after hip or knee replacement requiring ICU admission.
- Data collected included demographics, infection site, and severity scores (SAPS II, CCI, ASA).
Main Results:
- 57 patients (mean age 84.5 years) were included; 16 patients (28%) did not survive ICU stay.
- Non-survivors had significantly higher CCI, SAPS II scores, and required more invasive ventilation and renal replacement therapy (RRT).
- Multivariate analysis identified RRT, invasive ventilation, and CCI as independent risk factors for mortality.
Conclusions:
- Very elderly patients with PJI admitted to the ICU face a significant risk of poor outcomes.
- Independent risk factors for mortality include chronic infection, high SAPS II score, high CCI, invasive ventilation, and RRT.
Background:
Even though surgical techniques and implants have evolved, periprosthetic joint infection (PJI) remains a serious complication leading to poor postoperative outcome and a high mortality. The literature is lacking in studies reporting the mortality of very elderly patients with periprosthetic joint infections, especially in cases when an intensive care unit (ICU) treatment was necessary. We therefore present the first study analyzing patients with an age 80 and higher suffering from a periprosthetic joint infection who had to be admitted to the ICU.
Methods:
All patients aged 80 and higher who suffered from a PJI (acute and chronic) after THR or TKR and who have been admitted to the ICU have been included in this retrospective, observational, single-center study.
Results:
A total of 57 patients met the inclusion criteria. The cohort consisted of 24 males and 33 females with a mean age of 84.49 (± 4.0) years. The mean SAPS II score was 27.05 (± 15.7), the mean CCI was 3.35 (± 2.28) and the most patient had an ASA score of 3 or higher. The PJI was located at the hip in 71.9% or at the knee in 24.6%. Two patients (3.5%) suffered from a PJI at both locations. Sixteen patients did not survive the ICU stay. Non-survivors showed significantly higher CCI (4.94 vs. 2.73; p = 0.02), higher SAPS II score (34.06 vs. 24.32; p = 0.03), significant more patients who underwent an invasive ventilation (132.7 vs. 28.1; p = 0.006) and significantly more patients who needed RRT (4.9% vs. 50%; p < 0.001). In multivariate analysis, RRT (odds ratio (OR) 15.4, CI 1.69-140.85; p = 0.015), invasive ventilation (OR 9.6, CI 1.28-71.9; p = 0.028) and CCI (OR 1.5, CI 1.004-2.12; p = 0.048) were independent risk factors for mortality.
Conclusion:
Very elderly patients with PJI who needs to be admitted to the ICU are at risk to suffer from a poor outcome. Several risk factors including a chronic infection, high SAPS II Score, high CCI, invasive ventilation and RRT might be associated with a poor outcome.
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