High-Volume Hospitals Are Associated With Lower Rates of Mortality Following Revision Arthroplasty for Periprosthetic...

The relationship between hospital case volume and postoperative morbidity following revision arthroplasty for periprosthetic joint infection (PJI) has not been defined. As such, we sought to compare 90-day postoperative mortality rates among patients undergoing antibiotic spacer placement for PJI of the hip or knee between high- vs low-volume hospitals.

The Premier Healthcare Database was queried from 2016 to 2023 for adult patients undergoing antibiotic spacer placement for PJI. Using the Metropolis-Hastings algorithm, a single hospital volume threshold, below which mortality increased, was identified. Patients were divided by those operated on by high- vs low-volume hospitals. Multivariable logistic regression was conducted to assess odds of 90-day mortality and sepsis.

In a cohort of 55,670 PJIs, postoperative mortality was decreased in patients who were operated on by hospitals performing ≥35 antibiotic spacers annually (high volume). The adjusted odds of mortality (adjusted odds ratio = 0.76; 95% confidence interval = 0.65-0.88, P < .001) and sepsis (adjusted odds ratio = 0.69; 95% confidence interval = 0.66-0.73, P < .001) were significantly lower among patients operating at high-volume hospitals.

Patients receiving PJI care at hospitals performing greater than 35 antibiotic spacers annually died less frequently and had improved outcomes than those presenting to lower volume centers. These findings reinforce emerging evidence in support of centralized PJI care centers to improve patient survival.