Clostridium difficile Colitis Following Revision Total Knee Arthroplasty: Incidence and Risk Factors
| Autor: | Sanar S. Yokhana, Jaiben George, Linsen T. Samuel, Bryan E. Little, Gannon L. Curtis, Carlos A. Higuera-Rueda, Hussein F. Darwiche |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Comorbidity Clostridium Difficile Colitis 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors Internal medicine Odds Ratio Humans Medicine Orthopedics and Sports Medicine Arthroplasty Replacement Knee Perioperative Period Adverse effect Enterocolitis Pseudomembranous Aged 030222 orthopedics Clostridioides difficile business.industry Incidence Incidence (epidemiology) Perioperative Odds ratio Middle Aged Clostridium difficile Stepwise regression Colitis bacterial infections and mycoses Quality Improvement United States Anti-Bacterial Agents Diarrhea Logistic Models Clostridium Infections Female medicine.symptom business |
| Zdroj: | The Journal of Arthroplasty. 34:2785-2788 |
| ISSN: | 0883-5403 |
| DOI: | 10.1016/j.arth.2019.06.037 |
| Popis: | Background Clostridium difficile–associated diarrhea (CDAD) is associated with adverse events and financial liability. As institutions continue to adopt CDAD rates as a quality control metric, it is important to identify patients at risk before surgery, including revision total knee arthroplasty (rTKA). This study was conducted to (1) determine the incidence of CDAD within 30 days of rTKA and (2) identify perioperative risk factors for CDAD following rTKA. Methods The American College of Surgeons National Surgical Quality Improvement Program was queried to identify 6023 rTKA procedures from 2015-2016. Preoperative and perioperative variables, including patient demographics, lab values, comorbidities, operative time, procedure type, presence of postoperative infections, and rates of CDAD were collected. Chi-square and Fisher’s exact tests were used to detect differences between categorical variables, and t-tests were used to compare continuous variables. A stepwise logistic regression model was used to identify the risk factors for CDAD. Results The rate of CDAD within 30 days of rTKA was found to be 0.4% (24/6024). The CDAD rate following aseptic revision was 0.2% (12/4893), while the incidence of CDAD after septic revision was 1.1% (12/1130). Preoperative functional dependence (odds ratio [OR] = 5.14; P = .002), septic revision (OR = 2.77; P = .026), and cancer (OR = 14.26; P = .016) were statistically significant independent risk factors for CDAD after rTKA. Conclusion The incidence of CDAD after rTKA is approximately 0.4% in the United States. Independent risk factors for CDAD include septic revision, preoperative functional dependence, and cancer. Prevention of CDAD in these higher risk patients must be considered before surgery and antibiotic selection for other infections should be managed judiciously. |
| Databáze: | OpenAIRE |
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