Are We Winning or Losing the Battle With Periprosthetic Joint Infection: Trends in Periprosthetic Joint Infection and Mortality Risk for the Medicare Population

Periprosthetic joint infection (PJI) is a potentially deadly complication of total joint arthroplasty. This study was designed to address how the incidence of PJI and outcome of treatment, including mortality, are changing in the population over time. Primary total hip arthroplasty (THA) and total k...

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Vydané v:	The Journal of arthroplasty Ročník 33; číslo 10; s. 3238 - 3245
Hlavní autori:	Kurtz, Steven M., Lau, Edmund C., Son, Min-Sun, Chang, Ellen T., Zimmerli, Werner, Parvizi, Javad
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States Elsevier Inc 01.10.2018
Predmet:	Aged Aged, 80 and over Arthritis, Infectious - etiology Arthritis, Infectious - mortality Arthroplasty, Replacement, Hip - adverse effects Arthroplasty, Replacement, Knee - adverse effects cancer Female Humans Incidence infection Male Medicare mortality Proportional Hazards Models Prosthesis-Related Infections - etiology Prosthesis-Related Infections - mortality Risk Factors total hip arthroplasty total knee arthroplasty United States - epidemiology United States mortality total hip arthroplasty total knee arthroplasty infection cancer
ISSN:	0883-5403, 1532-8406, 1532-8406
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Abstract	Periprosthetic joint infection (PJI) is a potentially deadly complication of total joint arthroplasty. This study was designed to address how the incidence of PJI and outcome of treatment, including mortality, are changing in the population over time. Primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients with PJI from the 100% Medicare inpatient data set (2005-2015) were identified. Cox proportional hazards regression models for risk of PJI after THA/TKA (accounting for competing risks) or risk of all-cause mortality after PJI were adjusted for patient and clinical factors, with year included as a covariate to test for time trends. The unadjusted 1-year and 5-year risk of PJI was 0.69% and 1.09% for THA and 0.74% and 1.38% for TKA, respectively. After adjustment, PJI risk did not change significantly by year for THA (P = .63) or TKA (P = .96). The unadjusted 1-year and 5-year overall survival after PJI diagnosis was 88.7% and 67.2% for THA and 91.7% and 71.7% for TKA, respectively. After adjustment, the risk of mortality after PJI decreased significantly by year for THA (hazard ratio = 0.97; P < .001) and TKA (hazard ratio = 0.97; P < .001). Despite recent clinical focus on preventing PJI, we are unable to detect substantial decline in the risk of PJI over time, although mortality after PJI has declined. Because PJI risk appears not to be changing over time, the incidence of PJI is anticipated to scale up proportionately with the demand for THA and TKA, which is projected to increase substantially in the coming decade.
AbstractList	Periprosthetic joint infection (PJI) is a potentially deadly complication of total joint arthroplasty. This study was designed to address how the incidence of PJI and outcome of treatment, including mortality, are changing in the population over time. Primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients with PJI from the 100% Medicare inpatient data set (2005-2015) were identified. Cox proportional hazards regression models for risk of PJI after THA/TKA (accounting for competing risks) or risk of all-cause mortality after PJI were adjusted for patient and clinical factors, with year included as a covariate to test for time trends. The unadjusted 1-year and 5-year risk of PJI was 0.69% and 1.09% for THA and 0.74% and 1.38% for TKA, respectively. After adjustment, PJI risk did not change significantly by year for THA (P = .63) or TKA (P = .96). The unadjusted 1-year and 5-year overall survival after PJI diagnosis was 88.7% and 67.2% for THA and 91.7% and 71.7% for TKA, respectively. After adjustment, the risk of mortality after PJI decreased significantly by year for THA (hazard ratio = 0.97; P < .001) and TKA (hazard ratio = 0.97; P < .001). Despite recent clinical focus on preventing PJI, we are unable to detect substantial decline in the risk of PJI over time, although mortality after PJI has declined. Because PJI risk appears not to be changing over time, the incidence of PJI is anticipated to scale up proportionately with the demand for THA and TKA, which is projected to increase substantially in the coming decade. Periprosthetic joint infection (PJI) is a potentially deadly complication of total joint arthroplasty. This study was designed to address how the incidence of PJI and outcome of treatment, including mortality, are changing in the population over time.BACKGROUNDPeriprosthetic joint infection (PJI) is a potentially deadly complication of total joint arthroplasty. This study was designed to address how the incidence of PJI and outcome of treatment, including mortality, are changing in the population over time.Primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients with PJI from the 100% Medicare inpatient data set (2005-2015) were identified. Cox proportional hazards regression models for risk of PJI after THA/TKA (accounting for competing risks) or risk of all-cause mortality after PJI were adjusted for patient and clinical factors, with year included as a covariate to test for time trends.METHODSPrimary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients with PJI from the 100% Medicare inpatient data set (2005-2015) were identified. Cox proportional hazards regression models for risk of PJI after THA/TKA (accounting for competing risks) or risk of all-cause mortality after PJI were adjusted for patient and clinical factors, with year included as a covariate to test for time trends.The unadjusted 1-year and 5-year risk of PJI was 0.69% and 1.09% for THA and 0.74% and 1.38% for TKA, respectively. After adjustment, PJI risk did not change significantly by year for THA (P = .63) or TKA (P = .96). The unadjusted 1-year and 5-year overall survival after PJI diagnosis was 88.7% and 67.2% for THA and 91.7% and 71.7% for TKA, respectively. After adjustment, the risk of mortality after PJI decreased significantly by year for THA (hazard ratio = 0.97; P < .001) and TKA (hazard ratio = 0.97; P < .001).RESULTSThe unadjusted 1-year and 5-year risk of PJI was 0.69% and 1.09% for THA and 0.74% and 1.38% for TKA, respectively. After adjustment, PJI risk did not change significantly by year for THA (P = .63) or TKA (P = .96). The unadjusted 1-year and 5-year overall survival after PJI diagnosis was 88.7% and 67.2% for THA and 91.7% and 71.7% for TKA, respectively. After adjustment, the risk of mortality after PJI decreased significantly by year for THA (hazard ratio = 0.97; P < .001) and TKA (hazard ratio = 0.97; P < .001).Despite recent clinical focus on preventing PJI, we are unable to detect substantial decline in the risk of PJI over time, although mortality after PJI has declined. Because PJI risk appears not to be changing over time, the incidence of PJI is anticipated to scale up proportionately with the demand for THA and TKA, which is projected to increase substantially in the coming decade.CONCLUSIONDespite recent clinical focus on preventing PJI, we are unable to detect substantial decline in the risk of PJI over time, although mortality after PJI has declined. Because PJI risk appears not to be changing over time, the incidence of PJI is anticipated to scale up proportionately with the demand for THA and TKA, which is projected to increase substantially in the coming decade.
Author	Son, Min-Sun Kurtz, Steven M. Zimmerli, Werner Parvizi, Javad Chang, Ellen T. Lau, Edmund C.
Author_xml	– sequence: 1 givenname: Steven M. surname: Kurtz fullname: Kurtz, Steven M. organization: Exponent, Inc, Philadelphia, PA – sequence: 2 givenname: Edmund C. surname: Lau fullname: Lau, Edmund C. organization: Exponent, Inc, Menlo Park, CA – sequence: 3 givenname: Min-Sun surname: Son fullname: Son, Min-Sun organization: Exponent, Inc, Menlo Park, CA – sequence: 4 givenname: Ellen T. surname: Chang fullname: Chang, Ellen T. organization: Exponent, Inc, Menlo Park, CA – sequence: 5 givenname: Werner surname: Zimmerli fullname: Zimmerli, Werner organization: Kantonsspital Baselland, Basel University Medical Clinic and Interdisciplinary Unit for Orthopaedic Infections, Liestal, Switzerland – sequence: 6 givenname: Javad surname: Parvizi fullname: Parvizi, Javad organization: Rothman Institute, Philadelphia, PA
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/29914821$$D View this record in MEDLINE/PubMed
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Cites_doi	10.1016/j.arth.2017.02.027 10.1007/s11999-009-1013-5 10.2106/JBJS.M.01363 10.1007/s11999-011-1971-2 10.1016/j.arth.2012.02.022 10.2106/00004623-200704000-00012 10.1161/CIRCULATIONAHA.115.017719 10.1007/s11999-017-5333-6 10.1016/j.arth.2007.10.017 10.1016/j.arth.2009.04.027 10.2106/JBJS.M.00285 10.1080/01621459.1999.10474144 10.1056/NEJMra040181 10.1007/s11999-016-4717-3
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Snippet	Periprosthetic joint infection (PJI) is a potentially deadly complication of total joint arthroplasty. This study was designed to address how the incidence of...
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SubjectTerms	Aged Aged, 80 and over Arthritis, Infectious - etiology Arthritis, Infectious - mortality Arthroplasty, Replacement, Hip - adverse effects Arthroplasty, Replacement, Knee - adverse effects cancer Female Humans Incidence infection Male Medicare mortality Proportional Hazards Models Prosthesis-Related Infections - etiology Prosthesis-Related Infections - mortality Risk Factors total hip arthroplasty total knee arthroplasty United States - epidemiology
Title	Are We Winning or Losing the Battle With Periprosthetic Joint Infection: Trends in Periprosthetic Joint Infection and Mortality Risk for the Medicare Population
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