Dai Wen-Li, Lin Ze-Ming, Shi Zhan-Jun, Wang Jian
Department of Orthopedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
J Knee Surg. 2021 Sep;34(11):1227-1236. doi: 10.1055/s-0040-1702187. Epub 2020 Mar 4.
Although periprosthetic joint infection (PJI) has been hypothesized to increase the risk of complications following revision total knee arthroplasty (TKA), strong evidence linking the two is lacking. The aim of this study was to determine whether PJI is an independent risk factor for inpatient perioperative complications, and increased resource use in patients undergoing revision TKA. We relied on the US Nationwide Inpatient Sample (NIS) to identify patients with PJI or non-PJI treated with revision TKA between 2002 and 2014. Overall, 5,316 (16.4%) and 27,033 (83.6%) patients were categorized as PJI and non-PJI, respectively. To adjust for potential baseline differences between the two groups, propensity-score-based matching was performed. This resulted in 5,187 (50%) PJI patients matched to 5,187 (50%) non-PJI patients. The rates of postoperative complications, blood transfusions, prolonged length of stay (pLOS), in-hospital cost, and in-hospital mortality were assessed for both groups. Multivariable logistic regression analyses were performed within the cohort after propensity-score matching. For PJI versus non-PJI, respectively, the following rates were recorded: blood transfusions, 28.3 versus 18.4% ( < 0.0001); postoperative complications, 27.5 versus 19.8% ( < 0.0001); pLOS (>4 d), 61.9 versus 26.9% ( < 0.0001); in-hospital cost (>$39,929), 55.8 versus 44.2% ( < 0.0001); in-hospital mortality, 0.6 versus 0.3% ( = 0.016). In multivariable logistic regression analyses, PJI patients were more likely to receive a blood transfusion (odds ratio [OR]: 1.78; < 0.0001), to experience postoperative complications (OR: 1.56; < 0.0001), to have a higher in-hospital cost (OR: 1.65; < 0.0001), to have a pLOS following surgery following surgery (OR: 4.69; < 0.0001), and to have a higher in-hospital mortality (OR: 2.14; = 0.019). After adjustment for potential selection biases, PJI is associated with more adverse perioperative outcomes and resource use than non-PJI patients. This is a Level II (level of evidence), prognostic study.
尽管有人提出假体周围关节感染（PJI）会增加全膝关节置换术（TKA）翻修术后并发症的风险，但缺乏将两者联系起来的有力证据。本研究的目的是确定PJI是否是住院围手术期并发症以及TKA翻修患者资源使用增加的独立危险因素。我们依靠美国全国住院患者样本（NIS）来识别2002年至2014年间接受TKA翻修治疗的PJI或非PJI患者。总体而言，分别有5316例（16.4%）和27033例（83.6%）患者被归类为PJI和非PJI。为了调整两组之间潜在的基线差异，进行了基于倾向评分的匹配。这使得5187例（50%）PJI患者与5187例（50%）非PJI患者相匹配。评估了两组患者的术后并发症、输血、住院时间延长（pLOS）、住院费用和住院死亡率。在倾向评分匹配后的队列中进行了多变量逻辑回归分析。对于PJI组与非PJI组，分别记录了以下比率：输血率，28.3%对18.4%（<0.0001）；术后并发症发生率，27.5%对19.8%（<0.0001）；pLOS（>4天），61.9%对26.9%（<0.0001）；住院费用（>$39929），55.8%对44.2%（<0.0001）；住院死亡率，0.6%对0.3%（=0.016）。在多变量逻辑回归分析中，PJI患者更有可能接受输血（优势比[OR]：1.78；<0.0001），发生术后并发症（OR：1.56；<0.0001），住院费用更高（OR：1.65；<0.0001），术后有更长的住院时间（OR：4.69；<0.0001）以及更高的住院死亡率（OR：2.14；=0.019）。在调整潜在的选择偏倚后，与非PJI患者相比，PJI与更多不良围手术期结局和资源使用相关。这是一项II级（证据级别）预后研究。
