Systematic review of risk prediction scores for surgical site infection or periprosthetic joint infection following joint arthroplasty

Abstract

Accurate identification of individuals at high risk of surgical site infections (SSIs) or periprosthetic joint infections (PJIs) influences clinical decisions and development of preventive strategies. We aimed to determine progress in the development and validation of risk prediction models for SSI or PJI using a systematic review. We searched for studies that have developed or validated a risk prediction tool for SSI or PJI following joint replacement in MEDLINE, EMBASE, Web of Science and Cochrane databases; trial registers and reference lists of studies up to September 2016. Nine studies describing 16 risk scores for SSI or PJI were identified. The number of component variables in a risk score ranged from 4 to 45. The C-index ranged from 0·56 to 0·74, with only three risk scores reporting a discriminative ability of >0·70. Five risk scores were validated internally. The National Healthcare Safety Network SSIs risk models for hip and knee arthroplasties (HPRO and KPRO) were the only scores to be externally validated. Except for HPRO which shows some promise for use in a clinical setting (based on predictive performance and external validation), none of the identified risk scores can be considered ready for use. Further research is urgently warranted within the field.

Risk factors for surgical site infections using a data-driven approach

“…We identified 24 research papers, published from 2008 until 2019, which contained statistically significant results from a multivariate analysis. A total of 79 risk factors were identified for the three groups of surgical procedures [ 11 – 13 , 16 , 23 , 36 – 54 ] ( S1 Table ). Age, ASA class, body mass index (BMI), preoperative length of stay and diabetes were identified as general risk factors from the literature search.…”

“…Multivariate logistic regression is the most common statistical model used to identify risk factors in longitudinal study design data [ 16 ]. Not all studies report the discriminatory power of the multivariate logistic regression model fitted.…”

Development and validation of baseline, perioperative and at-discharge predictive models for postsurgical prosthetic joint infection

“…These scores apply to elective total knee arthroplasty (TKA), THA, hip hemiarthroplasty and unicompartmental knee prosthesis. Previous studies focused only on THA, TKA, or both [5,10]. Hemiarthroplasty was included here because although the reason for implantation is a fracture, it is also a clean surgery with similar management to other arthroplasties.…”

“…Prosthetic joint infections (PJI) are associated with important morbidity and increased costs [1]. Previous studies have identified many risk factors for PJI [2e4], and although several risk scores have been developed, their applicability and utility are limited [5]. A recent systematic review concluded that none of the identified risk scores so far could be considered ready for use except one for total hip arthroplasty (THA) [5].…”

Mildly decreased preoperative bilirubin levels are considered as risk factors for periprosthetic joint infection after total hip and knee arthroplasty

“…Given the severity of PJI, previous studies have identi ed a tremendous number of risk factors for PJI [6][7][8][9]; they can be divided into the patient (intrinsic factor) and environment (extrinsic factor) and play a crucial part in pre-, intra-or post-operative period. Many blood biomarkers are routinely assessed before joint arthroplasty, but only few are commonly used to guide surgeons in determining patients most at risk of PJI [10].…”