Characteristics, management, and in-hospital mortality among patients with severe sepsis in intensive care units in Japan: the FORECAST study.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The study protocol was reviewed and approved by the ethics committee of all participant institutes in the Japanese Association for Acute Medicine (JAAM) study group, Japan. (IRB number 014–0306 on Hokkaido University, the representative for FORECAST). CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER’S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 5. J Arthroplasty. 2018 Sep;33(9):2997-3002. doi: 10.1016/j.arth.2018.05.001. Epub 2018 May 9. Short-term Complications After Revision Hip Arthroplasty for Prosthetic Joint Infection Are Increased Relative to Noninfectious Revisions. Boddapati V(1), Fu MC(2), Tetreault MW(3), Blevins JL(2), Richardson SS(2), Su EP(2). Author information: (1)Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York. (2)Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York. (3)Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois. BACKGROUND: Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is associated with significant morbidity and cost. The purpose of this study was to determine how rates of perioperative complications, operative duration, and postoperative length of stay (LOS) in patients undergoing revision THA for PJI compare to primary THA and to revision THA for non-PJI. METHODS: We used the National Surgical Quality Improvement Program registry from 2005 to 2015 to identify all patients who underwent primary and revision THA. Patients were placed into cohorts based on the surgical procedure and by indication, including (1) primary THA, (2) revision THA for PJI, and (3) revision THA for non-PJI. Differences in 30-day postoperative medical complications, hospital readmissions, operative duration, and LOS were compared using bivariate and multivariate analyses. RESULTS: One lakh fourteen thousand five hundred five THA patients were identified, with 102,460 (89.5%) patients undergoing a primary THA and 12,045 (10.5%) undergoing a revision procedure. Of the 12,045 revision procedures, 10,777 (89.5%) were for non-PJI indications and 1268 (10.5%) were for PJI. Relative to primary THA, patients undergoing revision THA for PJI had an increased rate of total complications (odds ratio [OR] 3.96), sepsis (OR 13.15), deep surgical site infections (SSIs, OR 8.58), superficial SSI (OR 2.14, P = .002), nonhome discharge (OR 1.85), readmissions (OR 2.46), LOS (+3.0 days), and operative duration (+61 minutes). Compared with non-PJI revisions, PJI revisions had an increased rate of total complications (OR 2.42), sepsis (OR 5.51), deep SSI (OR 2.12), nonhome discharge (OR 1.47), and LOS (+1.8 days). CONCLUSION: Revision THA for PJI is associated with increased postoperative complications, nonhome discharge, and LOS relative to non-PJI revision THA. Separate care pathways and reimbursement bundles should be considered for patients with PJI. LEVEL OF EVIDENCE: III. Copyright © 2018 Elsevier Inc. All rights reserved. DOI: 10.1016/j.arth.2018.05.001