Bohl Daniel D, Sershon Robert A, Fillingham Yale A, Della Valle Craig J
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
J Arthroplasty. 2016 Dec;31(12):2875-2879.e2. doi: 10.1016/j.arth.2016.05.031. Epub 2016 May 27.
Sepsis is a rare but serious complication following total joint arthroplasty (TJA). Common sources include urinary tract infection (UTI), surgical site infection (SSI), and pneumonia. The purpose of this study is to characterize the incidence, risk factors, and sources of sepsis following TJA.
Patients undergoing primary total hip arthroplasty or total knee arthroplasty during 2005-2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Independent associations were tested for using multivariate regression adjusting for baseline characteristics.
A total of 117,935 patients were identified (45,612 undergoing total hip arthroplasty and 72,323 undergoing total knee arthroplasty). Of these, 402 (0.34%) developed sepsis following surgery. Patients who developed sepsis had an elevated mortality rate (3.7% vs 0.1%, P < .001). Among the 402 patients who developed sepsis, 124 (31%) had concomitant UTI, 110 (27%) SSI, and 60 (15%) pneumonia. Twenty-one patients (5%) had multiple infectious sources and 129 patients (32%) had no identifiable source. Independent risk factors for sepsis included greater age, male sex, functional dependence, insulin-dependent diabetes, hypertension, chronic obstructive pulmonary disease, current smoker, and greater operative time.
These findings suggest that the rate of sepsis following TJA is about 1 in 300, and that sepsis is associated with a high risk of mortality. The most common sources of sepsis are UTI, SSI, and pneumonia, potentially accounting for at least two-thirds of cases. The information provided here can be used to guide the diagnostic workup of sepsis in patients following TJA.
脓毒症是全关节置换术（TJA）后一种罕见但严重的并发症。常见来源包括尿路感染（UTI）、手术部位感染（SSI）和肺炎。本研究的目的是描述TJA后脓毒症的发病率、危险因素和来源。
在外科医师学会国家外科质量改进计划数据库中识别出2005年至2013年期间接受初次全髋关节置换术或全膝关节置换术的患者。使用多变量回归对基线特征进行调整，以检验独立关联。
共识别出117,935例患者（45,612例接受全髋关节置换术，72,323例接受全膝关节置换术）。其中，402例（0.34%）术后发生脓毒症。发生脓毒症的患者死亡率升高（3.7%对0.1%，P <.001）。在402例发生脓毒症的患者中，124例（31%）合并UTI，110例（27%）合并SSI，60例（15%）合并肺炎。21例患者（5%）有多种感染源，129例患者（32%）无明确感染源。脓毒症的独立危险因素包括年龄较大、男性、功能依赖、胰岛素依赖型糖尿病、高血压、慢性阻塞性肺疾病、当前吸烟者和手术时间较长。
这些发现表明，TJA后脓毒症的发生率约为300分之一，且脓毒症与高死亡风险相关。脓毒症最常见的来源是UTI、SSI和肺炎，可能占至少三分之二的病例。此处提供的信息可用于指导TJA术后患者脓毒症的诊断检查。
