1200 infection control & hospital epidemiology october 2015, vol. 36, no. 10
was mainly undergone in private hospitals (67%). In public settings, arthroplasty mainly took place in tertiary care uni- versity hospitals (53%). During follow-up, at least 1 comor- bidity was coded in 33% of hospital stays. The most frequently coded comorbidities were diabetes mellitus and cardiologic diseases (Tables 2–4). Crude patient mortality was 5.4% in the whole cohort with cardiovascular diseases and cancer as the main cause of death (17% and 12%, respectively), as in the general population. At baseline, among hip replacements,
70
significant differences existed depending on the indication of arthroplasty. Among hip replacements, baseline characteristics were different according to the replacement undergone. Total hip arthroplasty was performed on coxarthrosis cases (89%), whereas partial arthroplasty surgery mostly occurred after hip fracture (80%). Coxarthrosis represented 74% of the hip replacement stays, with more male (HR=0.88 vs 0.32 in hip fracture cases), a lower mean age (70.1 y [95% CI, 69.9– 70.3 y] vs 82.0 y [81.7–82.9 y] in hip fracture cases), and most surgical management in private sector (72% vs 32% for frac- ture management). Owing to the patient profile, among hip arthroplasty, mortality increased from 3% in coxarthrosis to 16% after hip fracture management.
60
Overall cohort rehospitalization HKAI rehospitalization
50 Characteristics of Outcome Events 40 30 20
PJI was identified in 604 of the 32,678 patients over the whole study period (Table 2). The sex ratio (male/female) was 0.86. The median (range) age of PJI patients was 75 (18–98) years, significantly lower in men (72.5 [18–98] y) than women (77 [25–98] y).The 1–year incidence of PJI was 1.31%(N =418 patients infected during the year after replacement). Annual PJI incidence increased significantly during the 4-year period from 1.02% to 1.69% for hip-associated infections and from 0.84% to 1.33% for knee-associated infections, with a slightly lower increase for knee. Overall density incidence was 2.3 per 100 person-years (95% CI, 2.0–2.6): 2.2 per 100 person-years (2.0–2.6) in hip replacement and 2.5 per 100 person-years (2.1–2.69) in knee replacement, without significant difference. Among hip replacements, again patient characteristics were
10 0
123456789 10 Number of rehospitalization
>10
fig1. Frequency of rehospitalization after hip or knee arthroplasty (hip or knee arthroplasty infection [HKAI] hospitalization included), 2008–2012 cohort (N=32,678 patients).
different after fracture or coxarthrosis: 2-fold more PJI after hip fracture management (2.6%) than coxarthrosis (1.3%), and more female (69%vs 42%), higher mean age (80 y vs 69.8 y), and more management in public sector (74% vs 36%), respectively. PJI occurred during the first 30 days after the replacement
for 183 patients (30.3%), of which 78 (42.6%) were during the replacement hospital stay. A total of 243 patients (40.1%) were infected between 1 month and 1 year; 178 (29.5%) were infected more than 1 year after joint replacement (Figure 2). The mean time between joint replacement and PJI diagnosis
table 2. Characteristics of the Patients With Prosthetic Joint Infection, 2008–2012 Patients undergoing HKA Sex ratio, M/F
Patients with hip SSI N=383 0.86
Age, median (range), y Follow-up, mean, d
Follow-up, median (range), d
Hospital sector N (%) Private Public
≥1 Coded comorbidity, N (%) Mortality rate, N (%)
77 (18–98) 236
49 (0–1,631) 145 (37.9)
238 (62.1) 259 (67.6) 51 (13.3)
Patients with knee SSI N=221 0.87
72 (24–92) 368
196 (0–1,626) 103 (46.6)
118 (53.4) 160 (72.4) 18 (8.1)
NOTE. No patients were lost to follow-up. HKA, hip or knee arthroplasty; SSI, surgical site infection.
Overall patients N=604 0.86
75 (18–98) 284
91 (0–1,631) 248 (41.1)
356 (58.9) 419 (69.3) 69 (11.4)
% of cohort patients
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