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Surgical Site Infection and Periprosthetic Joint Infection in Nonelective versus Elective Total Hip Arthroplasty
Uma Balachandran1, Graham Sabo, Hanish Kodali
1From the Department of Orthopaedic Surgery, Leni and Peter W. May, Icahn School of Medicine at Mount Sinai, New York, NY (Balachandran, Sabo, Dr. Kodali, Raymond, Rako, Stern, Moucha, Poeran, and Hayden), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery Science, New York, NY (Kodali and Stern), and Department of Anesthesiology, Hospital for Special Surgery, New York, NY (Poeran).
Introduction:
Total hip arthroplasty (THA) is a treatment used for both elective (eg, osteoarthritis) and nonelective (eg, fracture) indications. Patients undergoing nonelective THA may not be able to undergo the same preoperative optimization protocols as those undergoing elective THA. We aimed to determine differences in 30-day, 90-day, and 1-year surgical site infection (SSI) rates; 90-day and 1-year periprosthetic joint infection (PJI)-related revision; and 90-day and 1-year PJI-related surgery (ie, revision or irrigation and débridement) between nonelective and elective THA status.
Method:
This retrospective cohort study using the Medicare Limited Data Set included fee-for-service Medicare beneficiaries aged 65+ years who underwent inpatient primary THA in 2017 to 2020. Propensity score matching (1:5, nonelective: elective) was used. We assessed differences in surgical site infection (SSI), periprosthetic joint infection (PJI) outcomes by nonelective versus elective surgery status using mixed-effects logistic regression models, reporting adjusted odds ratios (OR) and 95% confidence intervals (CI).
Results:
From a total of 433,326 patients, 88,940 (19,094 nonelective; 69,846 elective) were successfully matched. Nonelective surgery status was associated with markedly higher odds of 30-day SSI (OR 1.55, 95% CI 1.25 to 1.92, P < 0.001), 90-day SSI (OR 1.53, 95% CI 1.30 to 1.78, P < 0.001), and 1-year SSI (OR 1.41, 95% CI 1.25 to 1.59, P < 0.001). Nonelective status was also associated with higher odds of 1-year PJI-related revision (OR 1.33, 95% CI 1.08-1.63, P = 0.006) but not 90-day PJI-related revision. Similarly, nonelective status was associated with higher odds of 1-year PJI-related surgery (OR 1.33, 95% CI 1.09 to 1.62, P = 0.004) but not 90-day PJI-related surgery.
Conclusion:
Nonelective THA status was an independent risk factor for SSI throughout the first postoperative year and for 1-year PJI-related revision and PJI-related surgery. Additional research is necessary to elucidate the etiology of observed differences in infection risk between patients undergoing nonelective and elective THA and to define strategies to mitigate this difference in infection risk.
