Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida.
J Arthroplasty. 2024 Sep;39(9S2):S410-S414. doi: 10.1016/j.arth.2024.03.052. Epub 2024 Mar 26.
Mortality is a quality indicator that may affect expenditures. Revisions for periprosthetic joint infection (PJI) are, on average, more expensive and exhibit higher morbidity than aseptic revisions, although reimbursement is similar. Therefore, we sought to determine (1) impact on mortality rates of revision total hip and/or knee arthroplasty performed for PJI diagnosis (septic) versus aseptic revisions, at any point in time, and (2) mortality predictors among PJI patients.
Retrospective chart review of 978 consecutive patients who underwent revision at a single institution (January 2015 to November 2020). All revisions were evaluated, and it was determined whether patients had a revision for PJI at any point in time or not. Two groups were compared: (1) patients with septic revision(s) (n = 350) and (2) patients who only underwent aseptic revision(s) (n = 628). Demographics and mortality status at latest follow-up (mean 3 years, range: 0 to 18 years, from first revision ever) were assessed. Mortality status was also separately assessed among patients who exclusively had hip revision(s), or solely knee revision(s), or both. Multivariate regression analysis (Cox) was used to determine whether PJI diagnosis was an independent mortality predictor. Among PJI patients, potential mortality predictors were evaluated.
Overall, 65 patients died (6.6%). The septic cohort had significantly more men and American Society of Anesthesiologists (ASA) class-IV patients. Mortality rates were 10.9% and 4.3% (P < .0001) for septic and aseptic revision groups, respectively. After controlling for sex, ASA, and number of revisions, PJI diagnosis was a significant mortality predictor (hazard ratio [HR]: 2.69, 95% confidence interval [CI]: 1.5 to 4.7, P = .001). Among PJI patients, age (HR: 1.05, 95% CI: 1.01 to 1.08, P = .009) and ASA (HR: 4.02, 95% CI: 1.67 to 9.67, P = .002) were independent predictors.
Having a revision due to PJI diagnosis was associated with 2.5 times increased mortality. Therefore, more accurate coding capturing the complexity and morbidity of revisions for PJI diagnosis is needed.
死亡率是一个可能影响支出的质量指标。与无菌翻修相比，假体周围关节感染（PJI）的翻修平均费用更高，发病率更高，尽管报销情况相似。因此，我们试图确定：（1）任何时候因 PJI 诊断（感染性）而行翻修全髋关节和/或膝关节置换术与无菌翻修相比，对死亡率的影响；（2）PJI 患者的死亡率预测因素。
对单机构 978 例连续翻修患者进行回顾性病历回顾（2015 年 1 月至 2020 年 11 月）。所有翻修均进行评估，并确定患者是否在任何时候因 PJI 而行翻修。将两组进行比较：（1）接受过感染性翻修的患者（n=350）和（2）仅接受过无菌翻修的患者（n=628）。评估最新随访时的人口统计学数据和死亡率（平均 3 年，范围：0 至 18 年，从第一次翻修开始）。还分别评估了仅接受髋关节翻修、仅接受膝关节翻修或两者均接受的患者的死亡率。采用多变量回归分析（Cox）确定 PJI 诊断是否为独立的死亡率预测因素。在 PJI 患者中，评估了潜在的死亡率预测因素。
总体而言，有 65 例患者死亡（6.6%）。感染性组的男性和美国麻醉医师协会（ASA）分级 IV 级患者明显更多。感染性和无菌性翻修组的死亡率分别为 10.9%和 4.3%（P<.0001）。在控制性别、ASA 和翻修次数后，PJI 诊断仍是显著的死亡率预测因素（风险比[HR]：2.69，95%置信区间[CI]：1.5 至 4.7，P=.001）。在 PJI 患者中，年龄（HR：1.05，95%CI：1.01 至 1.08，P=.009）和 ASA（HR：4.02，95%CI：1.67 至 9.67，P=.002）是独立的预测因素。
因 PJI 诊断而行翻修与死亡率增加 2.5 倍相关。因此，需要更准确的编码来捕捉 PJI 诊断翻修的复杂性和发病率。
