These authors used the Humana administrative claims database (Pearldiver Platform) to identify patients having primary total shoulder arthroplasty (TSA)(CPT code 23472 (total arthroplasty of glenohumeral joint with glenoid and proximal humeral replacement)).
Their study group consisted of patients who were coded as having periprosthetic infection (PJI) within 2-years after the index procedure (ICD-9 diagnosis code 996.66 (infection and inflammatory reaction due to internal joint prosthesis). Patients without this ICD-9 code served as the comparison cohort.
The query yielded 15,396 patients who underwent primary TSA for glenohumeral OA, of which 191 patients were coded as having PJIs and 15,205 were not. The criteria for the code of PJI were not described nor were the organisms responsible for the code of PJI.
Risk factors associated with a code for PJIs following primary TSA included: pathologic weight loss (OR: 2.06), obesity (BMI 30-40 kg/m sq) (OR: 1.56), male sex (OR: 1.52), and peripheral vascular disease (OR: 1.46). The criteria for pathologic weight loss or severity of peripheral vascular disease were not described.
Comment: This study highlights the limitations of using a claims database in which diagnostic criteria are undefined, allowing each person entering the codes to exercise their own opinion. This limitation is particularly problematic for periprosthetic infections of the shoulder: most of these infections are due to Cutibacterium which requires specific culturing protocols to identify them.
Using the data as presented, the table below was constructed:
The incidence of patients being coded as having PJI was highest for those in the youngest age group (55-59), for males, for those with pathologic weight loss and those with peripheral vascular disease.
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