In-Hospital Mortality Is Associated With Low-Volume Hip Revision Centers After Septic Revision Total Hip Arthroplasty

Area of Science:

• Orthopedic Surgery
• Infectious Disease
• Health Services Research

Background:

• Septic failure in revision total hip arthroplasty (rTHA) significantly increases patient morbidity and mortality compared to aseptic revisions.
• Understanding mortality risk factors and the impact of hospital volume is crucial for improving outcomes in septic rTHA.

Purpose of the Study:

• To determine the in-hospital mortality rate for patients undergoing septic rTHA.
• To assess the influence of hospital hip revision surgery volume (HRV) on mortality following septic rTHA.
• To identify independent risk factors associated with in-hospital mortality in septic rTHA patients with a 2-year follow-up.

Main Methods:

• Analysis of the Healthcare Cost and Utilization Project State Inpatient Databases (New York and Florida, 2007-2012).
• Identification of septic rTHA cases using International Classification of Diseases, Ninth Revision codes.
• Inclusion criteria: no prior THA for 2 years and 2 years of follow-up; control groups: primary THA and aseptic rTHA.
• Logistic regression analysis to evaluate independent associations with mortality.

Main Results:

• In-hospital mortality was 5.2% for septic rTHA (n=160), significantly higher than primary THA (2.9%) and aseptic rTHA (2.1%).
• Independent risk factors for mortality included octogenarian status, medium-risk, and high-risk Elixhauser comorbidity scores.
• Performing septic rTHA in high-HRV hospitals was associated with lower in-hospital mortality (AOR=0.539); low-HRV hospitals increased 2-year mortality risk.

Conclusions:

• Septic rTHA is associated with a substantially higher in-hospital mortality rate compared to primary or aseptic revision procedures.
• Patient factors like advanced age and high comorbidity burden are independent predictors of mortality after septic rTHA.
• Higher hospital hip revision surgery volume is associated with reduced in-hospital mortality, suggesting a potential benefit of specialized centers.