Periprosthetic joint infection after primary TKA in the medicare population: How frequently are patients revised at a different hospital? |
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| Institution: | 1. Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States;2. Department of Medicine, Division of Infectious Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States;1. The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK;2. Keele University, Staffordshire ST5 5BG, UK;1. Faculty of Medicine, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom;2. Department of Anesthesiology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore;3. Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore;4. Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore;5. SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme, Academic Level 4, 20 College Road, Singapore 169856, Singapore;1. Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan;2. Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama 343-8555, Japan;1. Department of Orthopedic Surgery, George Washington Hospital, Washington, DC, USA;2. Johns Hopkins Department of Orthopaedic Surgery, Adult Reconstruction Division, Columbia, MD, USA;3. Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA;1. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom;2. Nuffield Orthopaedic Centre, Oxford, United Kingdom |
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| Abstract: | BackgroundPeriprosthetic infection (PJI) after total knee arthroplasty (TKA) places a significant burden on hospitals. We sought to describe the proportion of patients undergoing revision for PJI at a different hospital within one year of primary TKA and whether patient characteristics or hospital volume were associated with this change.MethodsMedicare data from 2005 to 2014 was retrospectively reviewed using PearlDiver. All patients over 64 years undergoing revision for PJI within one year of primary TKA were stratified by the revision occurring within 90 days. Hospitals were grouped by annual TKA volume as Low (<50), Medium (51–100), High (101–200), and Very High (>200). Associations of patient characteristics and hospital volume with revision at a different hospital were assessed using Chi-squared tests and Somers' D.ResultsOf 8,337 patients undergoing revision within 90 days of TKA, 1,370 (16%) were revised at a different hospital. Changing hospitals was associated with having primary TKA at a lower volume hospital (24% for low, 15% medium, 12% high, and 12% very high; P < 0.001). Of 7,608 patients undergoing revision between 91 and 365 days, 1,110 (15%) were revised at a different hospital. Changing hospitals was associated with having primary TKA at a lower volume hospital (26% for low, 14% medium, 10% high, and 9% very high; P < 0.001). Changing hospitals was not associated with sex or age.ConclusionPatients frequently undergo revision for PJI at a different hospital, even within 90 days of TKA. Further research is needed to understand these implications of this care pathway shift. |
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| Keywords: | Periprosthetic joint infection Complications Total knee arthroplasty Revision total knee arthroplasty Medicare |
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