Marang-van de Mheen Perla J, Bragan Turner Ellie, Liew Susan, Mutalima Nora, Tran Ton, Rasmussen Sten, Nelissen Rob G H H, Gordon Andrew
Department of Medical Decision Making, Leiden University Medical Center, J10-S, PO Box 9600, 2300 RC, Leiden, The Netherlands.
Dr Foster Ltd, London, UK.
BMC Musculoskelet Disord. 2017 May 22;18(1):207. doi: 10.1186/s12891-017-1569-2.
To identify best practices and quality improvement initiatives, we aimed to assess whether the incidence of Periprosthetic Joint Infection (PJI) and treatment strategies differed across patients treated in Australian, European and United States (US) hospitals.
Routinely collected administrative data for 41397 patients undergoing a primary total hip or knee arthroplasty between July 2007-December 2010 across 22 hospitals were included. Patients were followed for 2 years looking for PJI occurrence, defined as early (within 4 weeks) and late PJI, and surgical treatment during 2.5 years after PJI diagnosis. Logistic and Poisson regression models were used to test for differences in PJI occurrence and treatment strategies across the three geographical regions, adjusted for age, sex, joint and Elixhauser comorbidity groups.
PJI occurrence varied from 1.4% in European to 1.7% in Australian patients, which were significantly higher than US patients after adjustment for patient characteristics (OR 1.24 [1.01-1.52] and 1.40 [1.03-1.91] respectively). Early PJIs varied between 0.3% in European to 0.6% in Australian patients, but adjusted rates were similar. Revision following PJI was significantly lower in Australian than in US patients (OR 0.46 [0.25-0.86]) as were the total number of revisions (RR 0.51 [0.36-0.71]) and number of surgical procedures (RR 0.60 [0.44-0.81]) used to treat PJI.
The overall PJI rate was significantly higher in Australian patients, but fewer procedures were needed to treat these PJIs. Future research should reveal whether this reflects PJIs caught earlier or less severe when diagnosed, and whether this is associated with the longer length of stay after primary arthroplasty in Australian hospitals.
为确定最佳实践和质量改进措施，我们旨在评估澳大利亚、欧洲和美国医院接受治疗的患者中，人工关节周围感染（PJI）的发生率和治疗策略是否存在差异。
纳入了2007年7月至2010年12月期间在22家医院接受初次全髋关节或膝关节置换术的41397例患者的常规收集的管理数据。对患者进行了2年的随访，以寻找PJI的发生情况，PJI定义为早期（4周内）和晚期PJI，以及PJI诊断后2.5年内的手术治疗情况。使用逻辑回归和泊松回归模型来检验三个地理区域之间PJI发生率和治疗策略的差异，并对年龄、性别、关节和埃利克斯豪泽合并症组进行了调整。
PJI发生率在欧洲患者中为1.4%，在澳大利亚患者中为1.7%，在根据患者特征进行调整后，这两个地区的发生率均显著高于美国患者（分别为OR 1.24 [1.01 - 1.52]和1.40 [1.03 - 1.91]）。早期PJI在欧洲患者中为0.3%，在澳大利亚患者中为0.6%，但调整后的发生率相似。澳大利亚患者PJI后的翻修率显著低于美国患者（OR 0.46 [0.25 - 0.86]），用于治疗PJI的翻修总数（RR 0.51 [0.36 - 0.71]）和手术程序数量（RR 0.60 [0.44 - 0.81]）也低于美国患者。
澳大利亚患者的总体PJI率显著较高，但治疗这些PJI所需的手术程序较少。未来的研究应揭示这是否反映了PJI在诊断时被更早发现或病情较轻，以及这是否与澳大利亚医院初次关节置换术后较长的住院时间有关。
