In-hospital mortality of patients with periprosthetic joint infection

Jan Reinhard; Siegmund Lang; Nike Walter; Melanie Schindler; Susanne Bärtl; Dominik Szymski; Volker Alt; Markus Rupp

doi:10.1302/2633-1462.54.BJO-2023-0162.R1

In-hospital mortality of patients with periprosthetic joint infection

Bone Jt Open. 2024 Apr 26;5(4):367-373. doi: 10.1302/2633-1462.54.BJO-2023-0162.R1.

Authors

Jan Reinhard^{1

2}, Siegmund Lang², Nike Walter², Melanie Schindler², Susanne Bärtl^{2

3}, Dominik Szymski², Volker Alt², Markus Rupp²

Affiliations

¹ Department of Orthopaedic Surgery, University Medical Center Regensburg, Regensburg, Germany.
² Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany.
³ Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany.

PMID: 38663864
PMCID: PMC11045279
DOI: 10.1302/2633-1462.54.BJO-2023-0162.R1

Abstract

Aims: Periprosthetic joint infection (PJI) demonstrates the most feared complication after total joint replacement (TJR). The current work analyzes the demographic, comorbidity, and complication profiles of all patients who had in-hospital treatment due to PJI. Furthermore, it aims to evaluate the in-hospital mortality of patients with PJI and analyze possible risk factors in terms of secondary diagnosis, diagnostic procedures, and complications.

Methods: In a retrospective, cross-sectional study design, we gathered all patients with PJI (International Classification of Diseases (ICD)-10 code: T84.5) and resulting in-hospital treatment in Germany between 1 January 2019 and 31 December 2022. Data were provided by the Institute for the Hospital Remuneration System in Germany. Demographic data, in-hospital deaths, need for intensive care therapy, secondary diagnosis, complications, and use of diagnostic instruments were assessed. Odds ratios (ORs) with 95% confidence intervals (CIs) for in-hospital mortality were calculated.

Results: A total of 52,286 patients were included, of whom 1,804 (3.5%) died. Hypertension, diabetes mellitus, and obesity, the most frequent comorbidities, were not associated with higher in-hospital mortality. Cardiac diseases as atrial fibrillation, cardiac pacemaker, or three-vessel coronary heart disease showed the highest risk for in-hospital mortality. Postoperative anaemia occurred in two-thirds of patients and showed an increased in-hospital mortality (OR 1.72; p < 0.001). Severe complications, such as organ failure, systemic inflammatory response syndrome (SIRS), or septic shock syndrome showed by far the highest association with in-hospital mortality (OR 39.20; 95% CI 33.07 to 46.46; p < 0.001).

Conclusion: These findings highlight the menace coming from PJI. It can culminate in multi-organ failure, SIRS, or septic shock syndrome, along with very high rates of in-hospital mortality, thereby highlighting the vulnerability of these patients. Particular attention should be paid to patients with cardiac comorbidities such as atrial fibrillation or three-vessel coronary heart disease. Risk factors should be optimized preoperatively, anticoagulant therapy stopped and restarted on time, and sufficient patient blood management should be emphasized.