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Prior Nonshoulder Periprosthetic Joint Infection Increases the Risk of Surgical Site Infection, Sepsis, and All-Cause
Amil R Agarwal1, Kevin Y Wang, Jacob D Mikula
1From the Department of Orthopedic Surgery, George Washington Hospital, Washington, DC (Agarwal, Berger), the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Wang, Mikula, Kreulen, Nayar, Best, Srikumaran), and the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Nayar, Best).
Introduction:
Periprosthetic joint infection (PJI) after total joint arthroplasty is a known risk factor for infection in subsequent joint arthroplasty. The purpose of this study was to determine whether prior nonshoulder PJI contributes to the increased risk of infectious complications, greater healthcare utilization, and increased revision surgery after primary total shoulder arthroplasty (TSA).
Methods:
Patients who underwent primary TSA for osteoarthritis with prior nonshoulder PJI were identified in a national database (PearlDiver Technologies) using Current Procedural Terminology and International Classification of Diseases codes. These patients were propensity matched based on age, sex, Charlson Comorbidity Index, smoking status, and obesity (body mass index >30 kg/m2) to a control cohort of patients who underwent primary TSA for osteoarthritis without any prior PJI. Primary outcomes include 1- and 2-year revision rates. Secondary outcomes include healthcare-specific outcomes of readmission, emergency department visits, length of stay, and mortality. Bivariate analysis was conducted using chi-square tests to compare all outcomes and complications between both cohorts.
Results:
Compared with patients without prior PJI, those with prior PJI had a significantly higher risk of 90-day surgical site infection (7.61% versus 0.56%) and sepsis (1.79% versus 0.56%) after TSA (P < 0.05 for both). Patients with prior PJI also had a higher risk of 90-day readmission compared with those without prior PJI (3.36% versus 1.23%, P = 0.008). In terms of surgical complications, patients with prior PJI had significantly higher risk of 2-year revision surgery compared with patients without prior PJI (3.36% versus 1.57%, P = 0.034).
Conclusion:
Prior nonshoulder PJI of any joint increases rates of 90-day surgical site infection, sepsis, and hospital readmission, as well as 2-year all-cause revision after TSA. These results are important for risk-stratifying patients undergoing TSA with prior history of PJI.
Level Of Evidence:
III.
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