Moderating Effects of Immunosuppressive Medications and Risk Factors for Post-Operative Joint Infection Following Total Joint Arthroplasty in Patients with Rheumatoid Arthritis or Osteoarthritis

Autor: Elizabeth Salt, David M. Mannino, Ryan P. Donegan, Brent J. Morris, Mary Kay Rayens, Andrew R. Hoellein, Amanda T. Wiggins, Leslie J. Crofford
Jazyk: angličtina
Rok vydání: 2016
Předmět:
Male
Gout
medicine.medical_treatment
Arthroplasty
Replacement
Hip
HIV Infections
Osteoarthritis
Comorbidity
Osteoarthritis
Hip
Arthritis
Rheumatoid
0302 clinical medicine
Risk Factors
Neoplasms
Lupus Erythematosus
Systemic
Arthroplasty
Replacement
Knee
030222 orthopedics
Shoulder Joint
Middle Aged
Osteoarthritis
Knee
Exact test
Arthroplasty
Replacement
Shoulder
Rheumatoid arthritis
Current Procedural Terminology
Female
Immunosuppressive Agents
medicine.medical_specialty
Prosthesis-Related Infections
Allopurinol
Article
Gout Suppressants
03 medical and health sciences
Sex Factors
Rheumatology
Internal medicine
medicine
Diabetes Mellitus
Humans
Surgical Wound Infection
Obesity
Arthroplasty
Replacement
Glucocorticoids
Aged
Retrospective Studies
030203 arthritis & rheumatology
business.industry
Immunologic Deficiency Syndromes
Odds ratio
Perioperative
medicine.disease
Arthroplasty
Anesthesiology and Pain Medicine
Logistic Models
Case-Control Studies
Multivariate Analysis
Physical therapy
Prednisone
business
Popis: 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 evidence-based perioperative total joint arthroplasty recommendations to improve surgical outcomes. Thus, the aim of this study was to describe risk factors for developing a post-operative 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, and diabetes mellitus] that are linked to infection status, controlling for length of follow-up.A retrospective, case-control study (N = 2212) using de-identified patient health claims information from a commercially insured, U.S. dataset representing 15 million patients annually (from January 1, 2007 to December 31, 2009) was conducted. Descriptive statistics, t-test, chi-square test, Fisher's exact test, and multivariate logistic regression were used.Male gender (OR = 1.42, p0.001), diagnosis of RA (OR = 1.47, p = 0.031), diabetes mellitus (OR = 1.38, p = 0.001), obesity (OR = 1.66, p0.001) or gout (OR = 1.95, p = 0.001), and a prescription for prednisone (OR = 1.59, p0.001) predicted a post-operative infection following total joint arthroplasty. Persons with post-operative joint infections were significantly more likely to be prescribed allopurinol (p = 0.002) and colchicine (p = 0.006); no significant difference was found for the use of specific disease-modifying anti-rheumatic drugs and TNF-α inhibitors.High-risk, post-operative joint infection groups were identified allowing for precautionary clinical measures to be taken.
Databáze: OpenAIRE
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