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Positive Preoperative Colonization With Methicillin Resistant Staphylococcus Aureus Is Associated With Inferior
Itay Ashkenazi1, Jeremiah Thomas2, Kyle W Lawrence2
1Department of Orthopaedic Surgery, NYU Langone Health, New York, New York; Division of Orthopaedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Background:
The impact of preoperative nasal colonization with methicillin resistant staphylococcus aureus (MRSA) on total joint arthroplasty (TJA) outcomes is not well understood. This study aimed to evaluate complications following TJA based on patients' preoperative staphylococcal colonization status.
Methods:
We retrospectively analyzed all patients undergoing primary TJA between 2011 and 2022 who completed a preoperative nasal culture swab for staphylococcal colonization. Patients were 1:1:1 propensity matched using baseline characteristics, and stratified into 3 groups based on their colonization status: MRSA positive (MRSA+), methicillin sensitive staphylococcus aureus positive (MSSA+), and MSSA/MRSA negative (MSSA/MRSA-). All MRSA+ and MSSA + underwent decolonization with 5% povidone iodine, with the addition of intravenous vancomycin for MRSA + patients. Surgical outcomes were compared between groups. Of the 33,854 patients evaluated, 711 were included in final matched analysis (237 per group).
Results:
The MRSA + TJA patients had longer hospital lengths of stay (P = .008), were less likely to discharge home (P = .003), and had higher 30-day (P = .030) and 90-day (P = .033) readmission rates compared to MSSA+ and MSSA/MRSA-patients, though 90-day major and minor complications were comparable across groups. MRSA + patients had higher rates of all-cause (P = .020), aseptic (P = .025) and septic revisions (P = .049) compared to the other cohorts. These findings held true for both total knee and total hip arthroplasty patients when analyzed separately.
Conclusion:
Despite targeted perioperative decolonization, MRSA + patients undergoing TJA have longer lengths of stay, higher readmission rates, and higher septic and aseptic revision rates. Surgeons should consider patients' preoperative MRSA colonization status when counseling on the risks of TJA.
Insights
Preoperative nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) increases risks for total joint arthroplasty (TJA) patients. Even with decolonization, MRSA+ patients face longer hospital stays, higher readmissions, and more revision surgeries.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Control
- Patient Safety
Background:
- Preoperative nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a potential risk factor for surgical site infections.
- The impact of MRSA colonization on total joint arthroplasty (TJA) outcomes remains incompletely understood.
- Evaluating TJA complications based on preoperative staphylococcal colonization status is crucial for patient management.
Purpose of the Study:
- To assess the association between preoperative nasal MRSA colonization and complications following TJA.
- To compare surgical outcomes in TJA patients stratified by MRSA, MSSA, and negative staphylococcal colonization status.
- To inform risk stratification and patient counseling for TJA procedures.
Main Methods:
- Retrospective analysis of 33,854 TJA patients (2011-2022) with preoperative nasal cultures.
- 1:1:1 propensity matching to create three groups: MRSA positive (MRSA+), methicillin-sensitive S. aureus positive (MSSA+), and negative (MSSA/MRSA-).
- MRSA+ and MSSA+ patients received decolonization; MRSA+ also received vancomycin. Outcomes were compared across groups.
Main Results:
- MRSA+ patients experienced longer hospital stays (P=.008) and lower home discharge rates (P=.003).
- Higher 30-day (P=.030) and 90-day (P=.033) readmission rates were observed in MRSA+ patients.
- MRSA+ patients had increased rates of all-cause (P=.020), aseptic (P=.025), and septic (P=.049) revisions compared to other groups.
Conclusions:
- Despite perioperative decolonization, MRSA+ TJA patients exhibit worse outcomes, including longer stays, higher readmissions, and increased revision rates.
- Preoperative MRSA colonization status is a significant factor influencing TJA complications.
- Surgeons should incorporate preoperative MRSA status into risk counseling for TJA candidates.
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