Risk factors and outcome of patients with periprosthetic joint infection admitted to intensive care unit

• Published in: Archives of orthopaedic and trauma surgery Vol. 140; no. 8; pp. 1081 - 1085
• Main Authors: Pöll, Alexandra Margarete, Baecker, Hinnerk, Yilmaz, Emre, Jansen, Oliver, Waydhas, Christian, Schildhauer, Thomas Armin, Hamsen, Uwe
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2020; Springer Nature B.V
• Subjects: Comorbidity; Infections; Intensive care; Knee Revision Surgery; Medicine; Medicine & Public Health; Mortality; Orthopedics; Prostheses; Renal replacement therapy; Risk factors; Sepsis; Discharge from ICU; Sepsis; Orthopedic surgery; Implant infection; Mortality
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-020-03471-x

Introduction Prosthetic joint infection (PJI) is a severe complication after total joint replacement surgery. The current study analyzes the outcome and mortality of patients admitted to an intensive care unit following PJI. Methods Retrospective analysis of all patients treated between 2012 and 2016 due to PJI in the surgical intensive care unit of a university hospital. Results A total of 124 patients were included. The mean age was 75 ± 11 years. Of those 124 patients, 85 patients (68.5%) suffered a prosthetic infection of the hip, 33 patients (27.3%) of the knee, six patients (4.8%) of hip and knee. 52 patients were male (40.9%). The assessed mean Simplified Acute Physiology Score II (SAPSII) was 29.6 ± 5.9. The mortality rate was 21% (26/124). Of surviving patients, 53.1% were discharged home, 25.5% were transferred to a nursing home, and 21.4% were transferred to a geriatric rehabilitation center. Comparing survivors to non-survivors, the non-survivor group showed a higher incidence of renal replacement therapy (46.1 vs 3.0%; p  < 0.01), higher SAPSII on admission (35.7 vs. 29.0; p  = 0.01) and higher Charlson Comorbidity Indices (CCI) (5.5 vs. 2.82; p  < 0.01). The multivariate regression identified CCI (odds ratio 1.49; p  < 0.01) and renal replacement therapy (odds ratio 12.4; p  < 0.01) as independent risk factors for increased mortality. Conclusions Admission to an intensive care unit was associated with a mortality rate of 21%. Factors associated with poor outcomes included renal replacement therapy, higher admission SAPII scores, and higher admission Charlson comorbidity index. These factors could be used for individual risk assessment on admission to the ICU.