Objective—Inconclusive findings about infection risks, importantly the use of immunosuppressive medications, in patients who have undergone large-joint total joint arthroplasty challenge efforts to provide evidenced-based perioperative total joint arthroplasty recommendations to improve surgical outcomes. Thus, the aim of this study was to describe risk factors for developing a postoperative infection in patients undergoing TJA of a large joint [total hip arthroplasty, total knee arthroplasty, or total shoulder arthroplasty] by identifying clinical and demographic factors, including the use of high risk medications (i.e., prednisone and immunosuppressive medications) and diagnoses (i.e., rheumatoid arthritis [RA], osteoarthritis [OA], gout, obesity, diabetes mellitus), that are linked to infection status, controlling for length of follow-up.
Methods—A retrospective, case-control study (N = 2,212) using de-identified patient health claims information from a commercially-insured, U.S. dataset representing 15 million patients annually (January 1, 2007 - December 31, 2009) was conducted. Descriptive statistics, t-test, chi-square test, Fisher's exact test, and multivariate logistic regression were used.
Results—Male gender (OR = 1.42; p < .001), diagnosis of RA (OR = 1.47; p = .031), diabetes mellitus (OR = 1.38, p = .001), obesity (OR = 1.66, p < .001) or gout (OR = 1.95; p = .001), and a prescription for prednisone (OR = 1.59; p < .001) predicted a post-operative infection following total joint arthroplasty. Persons with post-operative joint infections were significantly more likely to be prescribed allopurinol (p = .002) and colchicine (p = .006; no significant difference was found for the use of specific disease modifying anti-rheumatic drugs and TNF-α inhibitors.
Conclusion—High-risk, post-operative joint infection groups were identified allowing for precautionary clinical measures to be taken.
Digital Object Identifier (DOI)
This work was supported in part by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health [UL1TR000117]. Access to the large commercially insured dataset was made available with funding from CTSA UL1TR000117.
Salt, Elizabeth G.; Wiggins, Amanda T.; Rayens, Mary Kay; Morris, Brent J.; Mannino, David M.; Hoellein, Andrew; Donegan, Ryan P.; and Crofford, Leslie J., "Moderating Effects of Immunosuppressive Medications and Risk Factors for Post-Operative Joint Infection Following Total Joint Arthroplasty in Patients with Rheumatoid Arthritis or Osteoarthritis" (2017). Nursing Faculty Publications. 40.