An analysis of 90-day emergency department visits after peripherally inserted central catheter (PICC) placement for prosthetic joint infection

Abstract

Objective: Research on complications with peripherally inserted central catheter (PICC) lines that are placed for the treatment of prosthetic joint infection (PJI) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is scarce. We investigated the timing, frequency, and risk factors for PICC complications during treatment of PJI after THA and TKA. Methods: We retrospectively queried an institutional database for THA and TKA patients from January 2015 through December 2020 that developed a PJI and required PICC placement at an academic, tertiary-care referral center. Results: The study included 889 patients (48.3% female) with a mean age of 64.6 years (range, 18.7–95.2) who underwent 435 THAs and 454 TKAs that were revised for PJI. The cohort had 275 90-day ED visits (30.9%), and 51 (18.5%) were PICC related. The average time from discharge to PICC ED visit was 26.2 days (range, 0.3–89.4). The most common reasons for a 90-day ED visit were issues related to the joint replacement or wound site (musculoskeletal or MSK; n = 116, 42.2%) and PICC complaints (n = 51, 18.5%). A multivariable logistic regression demonstrated that non-White race (odds ratio [OR], 2.24; 95% confidence interval [CI], 1.24–4.04; P = .007) and younger age (OR, 0.98; 95% CI, 0.95–1.00; P = .035) were associated with PICC-related ED visits. Malposition/readjustment (41.2%) and occlusion (35.3%) were the most common PICC complications leading to ED presentation. Conclusions: PICC complications are common after PJI treatment, accounting for nearly 20% of 90-day ED visits.

Predictors of adverse safety events and unscheduled care among an outpatient parenteral antimicrobial therapy (OPAT) patient cohort

“…26 In a separate, smaller cohort of US-based patients receiving treatment for prosthetic joint infection, non-White race was associated with PICC-related ED visits. 27 Prior investigations evaluating care transitions beyond those specific to OPAT have demonstrated racial disparities in scheduled and unscheduled care following discharge from acute care. [28][29][30][31][32] Racial disparities in healthcare training and resources may underlie the outcomes of Black patients in our analysis.…”