提高丹麦膝关节置换登记处假体周围关节感染的数据采集：有效性评估和发病率估计。
Enhancing the data capture of periprosthetic joint infections in the Danish Knee Arthroplasty Registry: validity assessment and incidence estimation.
机构信息
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus University.
Department of Orthopedic Surgery, Hvidovre Hospital.
出版信息
Acta Orthop. 2024 Apr 9;95:166-173. doi: 10.2340/17453674.2024.40358.
BACKGROUND AND PURPOSE
Revisions due to periprosthetic joint infection (PJI) are underestimated in national arthroplasty registries. Our primary objective was to assess the validity in the Danish Knee Arthroplasty Register (DKR) of revisions performed due to PJI against the Healthcare-Associated Infections Database (HAIBA). The secondary aim was to describe the cumulative incidences of revision due to PJI within 1 year of primary total knee arthroplasty (TKA) according to the DKR, HAIBA, and DKR/HAIBA combined.
METHODS
This longitudinal observational cohort study included 56,305 primary TKAs (2010-2018), reported in both the DKR and HAIBA. In the DKR, revision performed due to PJI was based on pre- and intraoperative assessment disclosed by the surgeon immediately after surgery. In HAIBA, PJI was identified from knee-related revision procedures coinciding with 2 biopsies with identical microbiological pathogens. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of revision due to PJI in the DKR (vs. HAIBA, within 1 year of TKA) with 95% confidence intervals (CI). Cumulative incidences were calculated using the Kaplan-Meier method.
RESULTS
The DKR's sensitivity for PJI revision was 58% (CI 53-62) and varied by TKA year (41%-68%) and prosthetic type (31% for monoblock; 63% for modular). The specificity was 99.8% (CI 99.7-99.8), PPV 64% (CI 62-72), and NPV 99.6% (CI 99.6-99.7). 80% of PJI cases not captured by the DKR were caused by non-reporting rather than misclassification. 33% of PJI cases in the DKR or HAIBA were culture-negative. Considering potential misclassifications, the best-case sensitivity was 64%. The cumulative incidences of PJI were 0.8% in the DKR, 0.9% in HAIBA, and 1.1% when combining data.
CONCLUSION
The sensitivity of revision due to PJI in the DKR was 58%. The cumulative incidence of PJI within 1 year after TKA was highest (1.1%) when combining the DKR and HAIBA, showing that incorporating microbiology data into arthroplasty registries can enhance PJI validity.
背景与目的
假体周围关节感染（PJI）导致的翻修在国家关节置换登记处被低估了。我们的主要目标是评估丹麦膝关节置换登记处（DKR）中因 PJI 而进行的翻修与医疗保健相关感染数据库（HAIBA）相比的有效性。次要目的是根据 DKR、HAIBA 和 DKR/HAIBA 联合数据，描述初次全膝关节置换术（TKA）后 1 年内因 PJI 而进行翻修的累积发生率。
方法
这是一项纵向观察性队列研究，纳入了 56305 例初次 TKA（2010-2018 年），这些数据同时报告在 DKR 和 HAIBA 中。在 DKR 中，因 PJI 而进行的翻修是基于手术医生在手术后立即进行的术前和术中评估。在 HAIBA 中，通过与 2 次具有相同微生物病原体的膝关节相关翻修手术中的 2 次活检来确定 PJI。我们使用 95%置信区间（CI）计算了 DKR 中（与 TKA 后 1 年内的 HAIBA 相比）因 PJI 而进行的翻修的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。累积发生率使用 Kaplan-Meier 方法计算。
结果
DKR 对 PJI 翻修的敏感性为 58%（CI 53-62），且因 TKA 年份（41%-68%）和假体类型（单块 31%；模块 63%）而异。特异性为 99.8%（CI 99.7-99.8），PPV 为 64%（CI 62-72），NPV 为 99.6%（CI 99.6-99.7）。80%的 DKR 中未捕获的 PJI 病例是由于未报告而不是分类错误造成的。在 DKR 或 HAIBA 中，33%的 PJI 病例为培养阴性。考虑到潜在的分类错误，最佳情况下的敏感性为 64%。在 DKR 中，PJI 的累积发生率为 0.8%，HAIBA 中为 0.9%，两者结合时为 1.1%。
结论
DKR 中因 PJI 而进行的翻修的敏感性为 58%。初次 TKA 后 1 年内 PJI 的累积发生率最高（1.1%），当 DKR 和 HAIBA 结合时，表明将微生物学数据纳入关节置换登记处可以提高 PJI 的有效性。
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