These authors used the Nationwide Inpatient Sample to review 241,193 patients undergoing total shoulder arthroplasty or reverse total shoulder arthroplasty (TSA) and 159,795 undergoing hemiarthroplasty (HSA) between 2002 and 2011 to identify patients with an associated diagnosis of surgical site infection (SSI) during the admission. They found that
An in-hospital SSI developed in 0.08% of patients undergoing TSA or reverse TSA and in 0.11% of patients undergoing HSA. Independent risk factors for inpatient SSI included TSA vs HSA (odds ratio [OR], 1.83), Medicaid insurance vs private insurance (OR, 3.93), diagnosis of fracture nonunion (OR, 5.76), avascular necrosis (OR 2.71), or proximal humeral fracture (OR, 2.62) vs primary osteoarthritis, comorbidities, in-hospital events (blood transfusion, pneumonia, and acute renal failure), and increased duration of hospital stay.
They concluded that the small percentage of SSI occurring during the initial inpatient stay after shoulder arthroplasty is related to diagnoses other than primary osteoarthritis in more infirm patients with low-income government insurance (Medicaid).
Comment: While most surgical site infections of the shoulder are recognized long after the patient is discharged, this study once again drives home the influence of the 4Ps (problem, patient, procedure and physician). The authors showed that the problem (diagnosis other than osteoarthritis), the patient (insurance, comorbidities) and the procedure (total shoulder) were associated with higher rates of inpatient infections.
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