Saturday, August 8, 2015

Shoulder arthroplasty infection - risk factors

Periprosthetic shoulder infection in the United States: incidence and economic burden.

These authors used the Nationwide Inpatient Sample from 2002 to 2011 to analyze the historical incidence, predisposing factors, and economic burden of periprosthetic joint infection (PJI) after shoulder arthroplasty in the United States. Shoulder PJI was identified by ICD-9 diagnosis code 996.66 (prosthetic infection) in conjunction with shoulder prosthesis codes

The PJI rate was 0.98% from 2002 to 2011 and remained fairly constant over the period of study.
Comorbidities associated with PJI were weight loss/nutritional deficiency, drug abuse and anemia. The odds ratios are shown below.

Demographic factors associated with PJI were younger age and male gender
In 2011, median hospitalization costs for PJI were $17,163.57 compared with $16,132.68, $13,955.83, and $20,007.87 for total shoulder arthroplasty, hemiarthroplasty, and reverse arthroplasty, respectively.

Comment: This study gives us some data that may be useful in preoperative discussions with patients about their risk factors for infection. It has yet to be shown that modification of these risk factors will lower the rate of infection. 
This paper does not present data on which bacteria caused the PJI's. We now recognize that many periprosthetic infections of the shoulder are from Propionibacterium and that these infections are unlikely to be coded as infections because of their delayed presentation with subtle symptoms of otherwise unexplained pain and stiffness. Thus the rates presented in this article are likely to underestimate the actual incidence. 


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