Streamlining Hospital Treatment of Prosthetic Joint Infection
| Autor: | Eric R. Siegel, James R. Kee, Jeffrey B. Stambough, Paul K. Edwards, C. Lowry Barnes, Kevin M. Goodson, Simon C. Mears, Amanda J. Novack |
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| Rok vydání: | 2019 |
| Předmět: |
030222 orthopedics
medicine.medical_specialty Arthritis Infectious business.industry Arthroplasty Replacement Hip Prosthetic joint infection Length of Stay Hospitals 03 medical and health sciences 0302 clinical medicine Hospital treatment Internal medicine Chart review Health care Cohort Medicine Humans Orthopedics and Sports Medicine Fast track business Complication Arthroplasty Replacement Knee Acute hospital Retrospective Studies |
| Zdroj: | The Journal of arthroplasty. 35(3S) |
| ISSN: | 1532-8406 |
| Popis: | Background Prosthetic joint infection (PJI) is associated with significant morbidity, mortality, and costs. We developed a fast-track PJI care system using an infectious disease physician to work directly with the TJA service and coordinate in the treatment of PJI patients. We hypothesized that streamlined care of patients with hip and knee PJI decreases the length of the acute hospital stay without increasing the risk of complication or incorrect antibiotic selection. Methods A single-center retrospective chart review was performed for all patients treated operatively for PJI. A cohort of 78 fast-track patients was compared to 68 control patients treated before the implementation of the program. Hospital length of stay (LOS) and cases of antibiotic mismatch were primary outcomes. Secondary outcomes, including 90-day readmissions, reoperations, mortality, rate of reimplantation, and 12-month reimplant survival, were compared. Cox regressions were analyzed to assess the effects on LOS of patient demographics and the type of surgery performed. Results Average hospital LOS from infection surgery to discharge was significantly lower in the fast-track cohort (3.8 vs 5.7 days; P = .012). There were no episodes of antibiotic mismatch in the fast-track group vs 1 recorded episode in the control group. No significant differences were noted comparing 90-day complications, reimplantation rate, or 12-month reimplant survival rates. Conclusion Through the utilization of an orthopedic-specific infectious disease physician, a fast-track PJI protocol can significantly shorten hospital LOS while remaining safe. Streamlining care pathways may help decrease the overall healthcare costs associated with treating PJI. |
| Databáze: | OpenAIRE |
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