Surgical selection criteria compliance is associated with a lower risk of periprosthetic joint infection in total hip arthroplasty

Abstract

BackgroundPeriprosthetic joint infection (PJI) is a devastating complication of total hip arthroplasty (THA). Patient optimization represents an important target for PJI prevention. Unfortunately, best practice screening guidelines are not consistently followed by all surgeons. Our study aimed to determine both the degree and the effect that compliance with our institutional preoperative surgical selection criteria had on PJI rates for patients undergoing elective primary THA.MethodsA retrospective review was conducted on 455 elective primary THA procedures performed at an academic tertiary care center over a 2-year period. Institutional preoperative surgical selection criteria included the following: body mass index ≤40 kg/m2, hemoglobin A1c ≤7.5%, hemoglobin ≥12 g/dL, albumin ≥3.5 g/dL, no smoking within 30 days prior to surgery, and completion of a decolonization protocol if a nasal polymerase chain reaction was positive for Staphylococcus aureus. PJI was assessed for a minimum 1-year follow-up using Musculoskeletal Infection Society criteria from 2011. Rates of compliance and PJI were compared using a chi-squared test.ResultsSurgeon compliance with institutional preoperative selection criteria was 62.4% and ranged from 0.0% to 83.9%. Five of 455 patients developed a PJI. The total PJI rate was 1.1%. The compliant patient cohort had a PJI rate of 0.0%, while the noncompliant cohort had a PJI rate of 2.9% (P = .0038).ConclusionsThis study identified a statistically significant decrease in PJI rates among patients who met all preoperative screening criteria.

Enhanced Recovery After Primary Total Hip and Knee Arthroplasty

“…Recent analyses estimated the mean cost of primary total joint arthroplasty (TJA) to range from $17,000 to $30,000 for TKA and from $13,000 to $22,000 for THA, depending on the accounting method and whether the cost is assessed from the perspective of the patient, hospital, third-party payer, or society 5-7 . Continued cutbacks in bundled payment systems have increased efforts to reduce hospital length of stay and perioperative complications in the 90-day global period 6,8-12 . Recent evidence suggests that the opportunity for further optimization exists primarily among costs associated with space, equipment, and non-physician personnel utilized during the operative procedure, in addition to inpatient care and rehabilitation, all of which are targeted by standardized care pathways such as ERAS 5,13-16 .…”

Prevalence and potential influencing factors of non-superficial surgical site infection in patients with total hip arthroplasty: A systematic review and meta-analysis

“…The preoperative screening criteria included no smoking, BMI ≤ 40 kg/m2, hemoglobin A1c ≤ 7.5%, hemoglobin ≥ 12 g /dL, and albumin ≥ 3.5 g/dL within 30 days prior to surgery. [77] Consistently, our systematic review identi ed some important preoperative factors, including BMI, diabetes mellitus, ASA grade (assessment of the situation of systemic disease), serum albumin, immunosuppressive agents, that in uence the prevalence of NSSSI after THA. These results suggests that good basic conditions are important adjustable factors in reducing NSSSI after THA for patients undergoing elective surgery.…”

CORR Synthesis: How Might the Preoperative Management of Risk Factors Influence Healthcare Disparities in Total Joint Arthroplasty?

“…Many of these programs also use dedicated "navigators", who typically are nurses and social workers, to guide patients throughout the risk management process [7,12,19]. Other institutions simply implement preoperative surgical selection criteria without detailed guidance regarding the management of modifiable risk factors [50,51].…”