A desirability of outcome ranking (DOOR) for periprosthetic joint infection - a Delphi analysis

Brenton P Johns; David C Dewar; Mark R Loewenthal; Laurens A Manning; Amit Atrey; Nipun Atri; David G Campbell; Michael Dunbar; Christopher Kandel; Amir Khoshbin; Christopher W Jones; Jaime Lora-Tamayo; Catherine McDougall; Dirk Jan F Moojen; Jonathan Mulford; David L Paterson; Trisha Peel; Michael Solomon; Simon W Young; Joshua S Davis

doi:10.5194/jbji-7-221-2022

A desirability of outcome ranking (DOOR) for periprosthetic joint infection - a Delphi analysis

J Bone Jt Infect. 2022 Nov 10;7(6):221-229. doi: 10.5194/jbji-7-221-2022. eCollection 2022.

Authors

Brenton P Johns^{1

2}, David C Dewar^{1

2}, Mark R Loewenthal^{3

2}, Laurens A Manning⁴, Amit Atrey⁵, Nipun Atri⁶, David G Campbell⁷, Michael Dunbar⁸, Christopher Kandel⁹, Amir Khoshbin⁵, Christopher W Jones¹⁰, Jaime Lora-Tamayo¹¹, Catherine McDougall^{12

13}, Dirk Jan F Moojen¹⁴, Jonathan Mulford¹⁵, David L Paterson¹², Trisha Peel¹⁶, Michael Solomon¹⁷, Simon W Young¹⁸, Joshua S Davis^{3

2}

Affiliations

¹ The Bone and Joint Institute, Royal Newcastle Centre, New Lambton Heights, NSW, Australia.
² School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
³ Department of Immunology and Infectious Diseases, Royal Newcastle Centre, New Lambton Heights, NSW, Australia.
⁴ Medical School, University of Western Australia, Harry Perkins Research Institute, Fiona Stanley Hospital, Perth, WA, Australia.
⁵ Division of Orthopaedics, St. Michael's Hospital, University of Toronto, Toronto, OT, Canada.
⁶ Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Centre, Chicago, IL, USA.
⁷ Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.
⁸ Department of Orthopaedics, Halifax Infirmary & Dalhusie University, Halifax, NS, Canada.
⁹ Division of Infectious Diseases, University Health Network, Toronto, Ontario, Canada.
¹⁰ Orthopaedic Research Foundation Western Australia and Curtin University, Perth, WA, Australia.
¹¹ Instituto de investigación, imas12 (CIBERINFEC), Hospital Universitario 12 de Octubre, Madrid, Spain.
¹² Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
¹³ Department of Orthopaedics, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia.
¹⁴ Department of Orthopaedic and Trauma Surgery, Joint Research, OLVG, Amsterdam, the Netherlands.
¹⁵ Department Orthopaedic Surgery, Launceston General Hospital, Launceston, TAS, Australia.
¹⁶ Department of Infectious Disease, Monash University and Alfred Health, Melbourne, VIC, Australia.
¹⁷ Department of Orthopaedics, Prince of Wales Hospital, Randwick, NSW, Australia.
¹⁸ Department of Orthopaedic Surgery, University of Auckland, North Shore Hospital, Auckland, New Zealand.

Abstract

Background: Treatment outcomes in studies on prosthetic joint infection are generally assessed using a dichotomous outcome relating to treatment success or failure. These outcome measures neither include patient-centred outcome measures including joint function and quality of life, nor do they account for adverse effects of treatment. A desirability of outcome ranking (DOOR) measure can include these factors and has previously been proposed and validated for other serious infections. We aimed to develop a novel DOOR for prosthetic joint infections (PJIs). Methods: The Delphi method was used to develop a DOOR for PJI research. An international working group of 18 clinicians (orthopaedic surgeons and infectious disease specialists) completed the Delphi process. The final DOOR comprised the dimensions established to be most important by consensus with $> 75$ % of participant agreement. Results: The consensus DOOR comprised four main dimensions. The primary dimension was patient-reported joint function. The secondary dimensions were infection cure and mortality. The final dimension of quality of life was selected as a tie-breaker. Discussion: A desirability of outcome ranking for periprosthetic joint infection has been proposed. It focuses on patient-centric outcome measures of joint function, cure and quality of life. This DOOR provides a multidimensional assessment to comprehensively rank outcomes when comparing treatments for prosthetic joint infection.