Which Clinical and Patient Factors Influence the National Economic Burden of Hospital Readmissions After Total Joint Arthroplasty?

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Abstract

[Indexed for MEDLINE] 14. Acta Orthop. 2019 Dec;90(6):554-558. doi: 10.1080/17453674.2019.1644069. Epub 2019 Jul 24. General anesthesia might be associated with early periprosthetic joint infection: an observational study of 3,909 arthroplasties. Scholten R(1), Leijtens B(1), Hannink G(2), Kamphuis ET(3), Somford MP(1), van Susante JLC(1). Author information: (1)Rijnstate Ziekenhuis, Department of Orthopedics, Arnhem. (2)Radboud University Medical Center, Department of Operating Rooms, Nijmegen. (3)Rijnstate Ziekenhuis, Department of Anesthesiology, Arnhem, the Netherlands. Background and purpose - Periprosthetic joint infection (PJI) remains a devastating complication following total knee or total hip arthroplasty (TKA/THA). Nowadays, many studies focus on preventive strategies regarding PJI; however, the potential role of anesthesia in the development of PJI remains unclear.Patients and methods - All consecutive patients undergoing elective primary unilateral TKA or THA from January 2014 through December 2017 were included. Exclusion criteria included femoral fractures as the indication for surgery and previously performed osteosynthesis or hardware removal on the affected joint. Age, sex, BMI, ASA classification, type of arthroplasty surgery, type of anesthesia, duration of surgery, smoking status, and intraoperative hypothermia were recorded. Propensity score-matched univariable logistic regression analysis was used to control for allocation bias.Results - 3,909 procedures consisting of 54% THAs and 46% TKAs were available for analysis. 42% arthroplasties were performed under general anesthesia and 58% under spinal anesthesia. Early PJIs were observed in 1.7% of the general anesthesia group and in 0.8% in the spinal anesthesia group. The multivariable logistic regression model demonstrated an odds ratio for PJI of 2.0 (95% CI 1.0-3.7) after general anesthesia relative to the propensity score-matched patients who received spinal anesthesia.Interpretation - These results suggest a potential association between general anesthesia and early PJI. Future research using large-scale data is required to further elucidate this clinically relevant association. DOI: 10.1080/17453674.2019.1644069 PMCID: PMC6844397