Incidence, predictors, and outcomes of sepsis in revision total hip arthroplasty (rTHA)

Revision total hip arthroplasty (rTHA) is increasingly common, with sepsis being a serious but rare complication. Sepsis rates in rTHA vary widely, and understanding risk factors is crucial for improving outcomes. This study aims to evaluate the incidence of sepsis following rTHA and identify preoperative and intraoperative predictors.

A retrospective observational study using the ACS NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database analyzed 12,966 rTHA patients (2016-2021). Predictors of sepsis were identified through univariate and multivariate analysis, including demographic, comorbid, and surgical factors. The primary endpoint was identifying sepsis predictors; secondary endpoints included sepsis incidence across patient groups.

In a cohort of 12,966 patients undergoing revision total hip arthroplasty, the incidence of sepsis was 1.9% (251 patients). Preoperative factors associated with increased sepsis incidence included diabetes (2.6%), smoking (2.9%), dyspnea (3.7%), severe chronic obstructive pulmonary disease (COPD) (3.5%), dialysis (5.3%), open wounds (9.5%), steroid use (3.1%), partial/total dependence (3.5%), and American society of anesthesiologists (ASA) III-IV status (2.7%). Multivariate analysis identified several predictors of sepsis, including age (OR + 0.02 per year), total operation time (OR -0.004 per minute), open wounds (OR 3.6), severe COPD (OR 1.9), transfusion within 72 h (OR 3.3), dyspnea (OR 8.1), and emergent cases (OR 3.4). The sepsis group had higher adverse outcomes, including a 30-day mortality rate of 0.8% (vs. 0.22% in non-septic patients), higher rates of deep vein thrombosis (2.8% vs. 0.7%), pulmonary embolism (1.6% vs. 0.5%), stroke (0.8% vs. 0.2%), and acute renal failure (1.2% vs. 0.1%), all with significant p-values and higher odds ratios.

Sepsis after rTHA is a significant complication. Predictors include age, open wounds, COPD, dyspnea, and transfusions. Identifying at-risk patients can improve prevention and management strategies to enhance patient outcomes.