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Periprosthetic Joint Infection in Patients With Arthroplasty Undergoing Perioperative Colonoscopy
Ashley B Anderson1, Sean E Slaven1, Nora L Watson1
1Uniformed Services University-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland.
Importance:
Periprosthetic joint infection (PJI) is a rare but devastating complication. Most patients undergoing total joint arthroplasty (TJA) also need routine screening colonoscopy, in which transient bacteremia may be a potential source for hematogenous PJI. Patients and surgeons must decide on an optimal time span or sequence for these 2 generally elective procedures, but no such guidelines currently exist.
Objective:
To evaluate associations of colonoscopy with the risk of post-TJA PJI for the development of clinical practice recommendations for colonoscopy screening in patients undergoing TJA.
Design, Setting, And Participants:
This retrospective cohort study of Military Health System (MHS) beneficiaries older than 45 years who underwent TJA from January 1, 2010, to December 31, 2016, used propensity score matching and logistic regression to evaluate associations of colonoscopy with PJI risk. Statistical analyses were conducted between January and October 2023.
Exposure:
Colonoscopy status was defined by Current Procedural Terminology code for diagnostic colonoscopy within 6 months before or 6 months after TJA.
Main Outcomes And Measures:
Periprosthetic joint infection status was defined by a PJI International Classification of Diseases code within 1 year after TJA and within 1 year from the post-TJA index colonoscopy date.
Results:
Analyses included 243 671 patients (mean [SD] age, 70.4 [10.0] years; 144 083 [59.1%] female) who underwent TJA in the MHS from 2010 to 2016. In the preoperative colonoscopy cohort, 325 patients (2.8%) had PJI within 1 year postoperatively. In the postoperative colonoscopy cohort, 138 patients (1.8%) had PJI within 1 year from the index colonoscopy date. In separate analyses of colonoscopy status within 6 months before and 6 months after TJA, younger age, male sex, and several chronic health conditions (diabetes, kidney disease, and pulmonary disease) were each associated with higher PJI risk. However, no association was found with PJI risk for perioperative colonoscopy preoperatively (adjusted odds ratio, 1.10; 95% CI, 0.98-1.23) or postoperatively (adjusted odds ratio, 0.90; 95% CI, 0.74-1.08).
Conclusions And Relevance:
In this large retrospective cohort of patients undergoing TJA, perioperative screening colonoscopy was not associated with PJI and should not be delayed for periprocedural risk. However, health conditions were independently associated with PJI and should be medically optimized.
Insights
Routine screening colonoscopy before or after total joint arthroplasty (TJA) does not increase the risk of periprosthetic joint infection (PJI). Patients with underlying health conditions, however, face a higher PJI risk and should optimize their health before TJA.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Epidemiology
- Gastroenterology
Background:
- Periprosthetic joint infection (PJI) is a serious complication following total joint arthroplasty (TJA).
- Patients undergoing TJA often require routine screening colonoscopies, raising concerns about potential hematogenous PJI from transient bacteremia.
- Current guidelines are lacking for the optimal timing of these procedures.
Purpose of the Study:
- To investigate the association between colonoscopy timing and the risk of PJI after TJA.
- To inform clinical practice recommendations for colonoscopy screening in TJA patients.
Main Methods:
- Retrospective cohort study of over 243,000 Military Health System beneficiaries aged 45+ who underwent TJA between 2010 and 2016.
- Propensity score matching and logistic regression were used to analyze PJI risk associated with colonoscopies performed within six months before or after TJA.
- PJI was identified via ICD codes within one year post-TJA or post-colonoscopy.
Main Results:
- Perioperative colonoscopy (within 6 months before or after TJA) was not significantly associated with an increased risk of PJI.
- Preoperative colonoscopy showed an adjusted odds ratio of 1.10 (95% CI, 0.98-1.23) for PJI.
- Postoperative colonoscopy showed an adjusted odds ratio of 0.90 (95% CI, 0.74-1.08) for PJI.
- Factors independently associated with higher PJI risk included younger age, male sex, and comorbidities like diabetes, kidney disease, and pulmonary disease.
Conclusions:
- Perioperative screening colonoscopy should not be delayed due to concerns about increasing PJI risk after TJA.
- Patients with comorbidities should focus on medical optimization to mitigate their elevated PJI risk.
- The findings support concurrent scheduling of TJA and screening colonoscopies when clinically indicated.
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