Abstract
Background
Surgical site infections (SSIs) after total knee (TKA) and total hip (THA) arthroplasty
are devastating to patients and costly to healthcare systems. The purpose of this
study is to investigate the seasonality of TKA and THA SSIs at a national level.
Methods
All data were extracted from the National Readmission Database for 2013 and 2014.
Patients were included if they had undergone TKA or THA. We modeled the odds of having
a primary diagnosis of SSI as a function of discharge date by month, payer status,
hospital size, and various patient co-morbidities. SSI status was defined as patients
who were readmitted to the hospital with a primary diagnosis of SSI within 30 days
of their arthroplasty procedure.
Results
There were 760,283 procedures (TKA 424,104, THA 336,179) in our sample. Our models
indicate that SSI risk was highest for patients discharged from their surgery in June
and lowest for December discharges. For TKA, the odds of a 30-day readmission for
SSI were 30.5% higher at the peak compared to the nadir time (95% confidence interval
[CI] 20-42). For THA, the seasonal increase in SSI was 19% (95% CI 9-30). Compared
to Medicare, patients with Medicaid as the primary payer had a 49% higher odds of
30-day SSI after TKA (95% CI 32-68).
Conclusion
SSIs following TKA and THA are seasonal peaking in summer months. Payer status was
also a significant risk factor for SSIs. Future studies should investigate potential
factors that could relate to the associations demonstrated in this study.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of ArthroplastyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Surgical wound dehiscence in an Australian community nursing service: time and cost to healing.J Wound Care. 2016; 25: 377-383
- Surgical site infection: incidence and impact on hospital utilization and treatment costs.Am J Infect Control. 2009; 37: 387-397
- The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs.Infect Control Hosp Epidemiol. 1999; 20: 725-730
- Morbidity and mortality associated with surgical site infections: results from the 1997-1999 INCISO surveillance.J Hosp Infect. 2001; 48: 267-274
- Surgical site infection—a European perspective of incidence and economic burden.Int Wound J. 2004; 1: 247-273
- Causes and rates of unplanned readmissions after elective primary total joint arthroplasty: a systematic review and meta-analysis.Am J Orthop (Belle Mead NJ). 2015; 44: 397-405
- The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost.Infect Control Hosp Epidemiol. 2002; 23: 183-189
- Infection burden for hip and knee arthroplasty in the United States.J Arthroplasty. 2008; 23: 984-991
- Prosthetic joint infection risk after TKA in the Medicare population.Clin Orthop Relat Res. 2010; 468: 52-56
- Risk factors associated with surgical site infection in 30,491 primary total hip replacements.J Bone Joint Surg Br. 2012; 94: 1330-1338
- Prosthetic joint infection risk after total hip arthroplasty in the Medicare population.J Arthroplasty. 2009; 24: 105-109
- Hospitalization for total hip replacement among inpatients aged 45 and over: United States, 2000–2010.NCHS Data Brief. 2015; 186: 1-8
- Hospitalization for total knee replacement among inpatients aged 45 and over: United States, 2000–2010.NCHS Data Brief. 2015; 210
- Economic burden of periprosthetic joint infection in the United States.J Arthroplasty. 2012; 27: 61-65.e1
- Obesity and diabetes as risk factors for postoperative wound infections after cardiac surgery.Am J Infect Control. 1988; 16: 3-6
- Contributing factors to surgical site infections.J Am Acad Orthop Surg. 2012; 20: 94-101
- Incisional infection after colorectal surgery in obese patients.Acta Chir Scand. 1987; 153: 225-227
- Factors affecting the incidence of postoperative wound infection.J Hosp Infect. 1990; 16: 223-230
- Correlation of immune and nutritional status with wound complications in patients undergoing vascular operations.Surgery. 1983; 93: 822-827
- Operative morbidity and risk factor assessment in melanoma patients undergoing inguinal lymph node dissection.Am J Surg. 1992; 164 (discussion 465–466): 462-465
- Nasal carriage of Staphylococcus aureus is a major risk factor for surgical-site infections in orthopedic surgery.Infect Control Hosp Epidemiol. 2000; 21: 319-323
- The seasonal variability in surgical site infections and the association with warmer weather: a population-based investigation.Infect Control Hosp Epidemiol. 2017; 38: 809-816
- Postoperative infection in spine surgery: does the month matter?.J Neurosurg Spine. 2015; 23: 128-134
- The seasonality of postoperative infection in spine surgery.J Neurosurg Spine. 2013; 18: 57-62
- Seasonality of infection rates after total joint arthroplasty.Orthopedics. 2014; 37: e182-e186
- Seasonal variation of common surgical site infections: does season matter?.Infect Control Hosp Epidemiol. 2015; 36: 1011-1016
- Use of Medicare diagnosis and procedure codes to improve detection of surgical site infections following hip arthroplasty, knee arthroplasty, and vascular surgery.Infect Control Hosp Epidemiol. 2012; 33: 40-49
- Institutional and seasonal variations in the incidence and causative organisms for posttraumatic infection following open fractures.J Orthop Trauma. 2017; 31: 78-84
- A time-series analysis of Clostridium difficile and its seasonal association with influenza.Infect Control Hosp Epidemiol. 2010; 31: 382-387
- Seasonality of Clostridium difficile infections in Southern Germany.Epidemiol Infect. 2012; 140: 1787-1793
- The co-seasonality of pneumonia and influenza with Clostridium difficile infection in the United States, 1993-2008.Am J Epidemiol. 2013; 178: 118-125
- Seasonality of infectious diseases.Annu Rev Public Health. 2007; 28: 127-143
- Seasonality of symptomatic bacterial urinary infections in women.J Epidemiol Community Health. 1983; 37: 286-290
- The warmer the weather, the more gram-negative bacteria—impact of temperature on clinical isolates in intensive care units.PLoS One. 2014; 9: e91105
- Seasonal variation in Escherichia coli bloodstream infection: a population-based study.Clin Microbiol Infect. 2009; 15: 947-950
- The increase in hospitalizations for urinary tract infections and the associated costs in the United States, 1998–2011.Open Forum Infect Dis. 2017; 4: ofw281
- Increasing incidence, cost, and seasonality in patients hospitalized for cellulitis.Open Forum Infect Dis. 2017; 4: ofx008
- Warmer weather as a risk factor for cellulitis: a population-based investigation.Clin Infect Dis. 2017; 65: 1167-1173
- The environment and the microbial ecology of human skin.Appl Environ Microbiol. 1977; 33: 603-608
- Medicaid payer status is associated with in-hospital morbidity and resource utilization following primary total joint arthroplasty.J Bone Joint Surg Am. 2014; 96: e180
Article info
Publication history
Published online: October 31, 2017
Accepted:
October 24,
2017
Received in revised form:
October 20,
2017
Received:
October 1,
2017
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2017.10.043.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
