Infection Control & Hospital Epidemiology (2018), 39, 1189–1195 doi:10.1017/ice.2018.184
Original Article
The projected burden of complex surgical site infections following hip and knee arthroplasties in adults in the United States, 2020 through 2030
Hannah M. Wolford MSPH, Kelly M. Hatfield MSPH, Prabasaj Paul PhD, Sarah H. Yi PhD and Rachel B. Slayton PhD Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Abstract
Background: As the US population ages, the number of hip and knee arthroplasties is expected to increase. Because surgical site infections (SSIs) following these procedures contribute substantial morbidity, mortality, and costs, we projected SSIs expected to occur from 2020 through 2030. Methods: We used a stochastic Poisson process to project the number of primary and revision arthroplasties and SSIs. Primary arthroplasty rates were calculated using annual estimates of hip and knee arthroplasty stratified by age and gender from the 2012–2014 Nationwide Inpatient Sample and standardized by census population data. Revision rates, dependent on time from primary procedure, were obtained from published literature and were uniformly applied for all ages and genders. Stratified complex SSI rates for arthroplasties were obtained from 2012–2015 National Healthcare Safety Network data. To evaluate the possible impact of prevention measures, we recalculated the projections with an SSI rate reduced by 30%, the national target established by the US Department of Health and Human Services (HHS). Results: Without a reduction in SSI rates, we projected an increase in complex SSIs following hip and knee arthroplasty of 14% between 2020 and 2030. We projected a total burden of 77,653 SSIs; however, meeting the 30% rate reduction could prevent 23,297 of these SSIs. Conclusions: Given current SSI rates, we project that complex SSI burden for primary and revision arthroplasty may increase due to an aging population. Reducing the SSI rate to the national HHS target could prevent 23,000 SSIs and reduce subsequent morbidity, mortality, and Medicare costs.
(Received 9 May 2018; accepted 11 July 2018; electronically published August 30, 2018)
Hip and knee arthroplasties improve the quality of life for patients who receive elective surgery.1,2 The demand for arthro- plasty is anticipated to increase due to the aging US population and projected increases in obesity prevalence, leading to a con- comitant increase in the incidence of SSI.3–10 As of 2009, for every 1,000 hip and knee arthroplasties, roughly 6.9 patients developed a complex surgical site infection (SSI).11 SSIs are associated with increased perioperative mortality rate, length of stay, cost of in- hospital care, and additional procedures to address the infec- tion.12 To try to reduce these burdens, the US Department of Health and Human Services (HHS) has established a goal of lowering SSI rates by 30% by 2020 in the National Action Plan to Prevent Health Care-Associated Infections: Road Map Elimina- tion (HAI Action Plan).13 Previous studies have reported current SSI rates while asses- sing the infection burden;6,11,14 however, these rates do not
Author for correspondence: Hannah Wolford, 1600 Clifton Road MS A-16, Atlanta,
GA 30329. E-mail:
Lin5@cdc.gov PREVIOUS PRESENTATION: Preliminary findings were presented in part as an abstract at the IDWeek 2017 Annual Meeting on October 7, 2017, in San Diego, CA. Cite this article: Wolford H, et al. (2018). The projected burden of complex surgical
site infections following hip and knee arthroplasties in adults in the United States, 2020 through 2030. Infection Control & Hospital Epidemiology 2018, 39, 1189–1195. doi: 10.1017/ ice.2018.184
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
incorporate changes over time in burden and trends of arthro- plasties and SSIs. Without considering how changes in population denominators over time will affect the numbers of arthroplasties performed or the risk of SSI, we cannot reliably demonstrate the potential increase in infection and economic burden. Common conditions such as obesity and diabetes have been associated with SSIs and may be changing at the population level.6–10 Burden estimates incorporating such information could be used to set healthcare- associated infection (HAI) policy and to identify facilities for targeted intervention.15,16 To estimate the potential impact of achieving the HHS goal for
lowering SSIs while accounting for underlying time trends in population counts and intensity of arthroplasty, we projected primary and revision hip and knee arthroplasty SSIs using esti- mated and targeted SSI rates from 2020 through 2030 and assessed trends over time. We also assessed the effect of potential trends in comorbidities by conducting a secondary analysis modeling increasing obesity using stratified body mass index (BMI) scores.
Methods
We used a stochastic Poisson process to model the number of primary and revision hip and knee arthroplasties and subsequent
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