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The Otto Aufranc Award: Modifiable versus Nonmodifiable Risk Factors for Infection After Hip Arthroplasty

  • Symposium: 2014 Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights to this article was published on 13 August 2014

Abstract

Background

Periprosthetic joint infections (PJIs) are associated with increased morbidity and cost. It would be important to identify any modifiable patient- and surgical-related factors that could be modified before surgery to decrease the risk of PJI.

Questions/purposes

We sought to identify and quantify the magnitude of modifiable risk factors for deep PJIs after primary hip arthroplasty.

Methods

A series of 3672 primary and 406 revision hip arthroplasties performed at a single specialty hospital over a 3-year period were reviewed. All deep PJIs were identified using the Centers for Disease Control and Prevention case definitions (ie, occurs within 30–90 days postoperatively, involves deep soft tissues of the incision, purulent drainage, dehiscence and fever, localized pain or tenderness). Univariate and multivariate analyses determined the association between patient and surgical risk factors and PJIs. For the elective patients, the procedure was performed on the day of admission (“same-day procedure”), whereas for the fracture and nonelective patients, the procedure was performed 1 or more days postadmission (“nonsame-day procedure”). Staphylococcus aureus colonization, tobacco use, and body mass index (BMI) were defined as patient-related modifiable risk factors.

Results

Forty-seven (1.3%) deep PJIs were identified. Infection developed in 20 of 363 hips of nonsame-day procedures and 27 of 3309 same-day procedures (p = 0.006). There were eight (2%) infections in the revision group. After controlling for confounding variables, our multivariate analysis showed that BMI ≧ 40 kg/m2 (odds ratio [OR], 4.13; 95% confidence interval [CI], 1.3–12.88; p = 0.01), operating time > 115 minutes (OR, 3.38; 95% CI, 1.23–9.28; p = 0.018), nonsame-day surgery (OR, 4.16; 95% CI, 1.44–12.02; p = 0.008), and revision surgery (OR, 4.23; 95% CI, 1.67–10.72; p < 0.001) are significant risk factors for PJIs. Tobacco use and S aureus colonization were additive risk factors when combined with other significant risk factors (OR, 12.76; 95% CI, 2.47–66.16; p = 0.017).

Conclusions

Nonsame-day hip and revision arthroplasties have higher infection rates than same-day primary surgeries. These characteristics are not modifiable and should be categorized as a separate cohort for complication-reporting purposes. Potentially modifiable risk factors in our patient population include operating time, elevated BMI, tobacco use, and S aureus colonization. Modifying risk factors may decrease the incidence of PJIs. When reporting deep PJI rates, stratification into preventable versus nonpreventable infections may provide a better assessment of performance on an institutional and individual surgeon level.

Level of Evidence

Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, 301 East 17th Street, New York, NY, 10003, USA

    Guy Maoz MD, Joseph Bosco MD, James Slover MD, MS, Ifeoma Inneh MPH & Richard Iorio MD

  2. Department of Medicine: Epidemiology and Infection Control, NYU Langone Medical Center, New York, NY, USA

    Michael Phillips MD & Anna Stachel MPH

Authors
  1. Guy Maoz MD
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  2. Michael Phillips MD
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  3. Joseph Bosco MD
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  4. James Slover MD, MS
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  5. Anna Stachel MPH
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  6. Ifeoma Inneh MPH
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  7. Richard Iorio MD
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Corresponding author

Correspondence to Richard Iorio MD.

Additional information

One or more of the authors certifies that he (JB, RI), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from 3M (Minneapolis, MN, USA) and USD 10,000 to USD 100,000 from IMDS (Orlando, FL, USA) and Kyocera (Kyoto, Japan).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained (if applicable).

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Maoz, G., Phillips, M., Bosco, J. et al. The Otto Aufranc Award: Modifiable versus Nonmodifiable Risk Factors for Infection After Hip Arthroplasty. Clin Orthop Relat Res 473, 453–459 (2015). https://doi.org/10.1007/s11999-014-3780-x

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  • DOI: https://doi.org/10.1007/s11999-014-3780-x

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