A Higher Altitude Is Associated with Increased Incidence of Infections following Primary Total Hip Arthroplasty
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: The purpose of this study was to evaluate whether patients undergoing primary total hip arthroplasty (THA) at a higher elevation have higher rates of: 1) in-hospital length of stay (LOS); 2) surgical site infections (SSIs); 3) periprosthetic joint infections (PJIs); and 4) costs. Materials and Methods: The Medicare claims database was used to identify patients who underwent primary THA at an altitude higher than 4,000 feet (ft). High-altitude patients were matched to patients who underwent primary THA at an altitude less than 100 ft, yielding 24,958 and 124,765 patients respectively. Outcomes that were assessed included in-hospital LOS, SSIs, PJIs, and costs of care. A P-value less than 0.001 was considered statistically significant. Results: Patients in the study group had significantly longer in-hospital LOS (4 days vs 3 days, P<0.0001). In addition, patients in the study group had a significantly higher incidence and odds of developing SSIs (1.16% vs 0.86%; odds ratio [OR], 1.34; P<0.0001) and PJIs (0.91% vs 0.58%; OR, 1.56; P<0.0001) within 90-days following the index procedure, compared to matched controls. Higher altitude patients incurred higher day of surgery ($16,139.76 vs $15,279.42; P<0.0001) and 90-day costs ($18,647.51 vs $16,401.62; P<0.0001). Conclusion: This study demonstrated that primary THA procedures performed at an elevation higher than 4,000 ft are associated with longer in-hospital LOS, higher rates of SSIs, PJIs, and costs of care. Orthopedists and other healthcare professionals can use this information to provide adequate education for these patients regarding the potential complications that may occur following their procedure.
Abstract
Purpose: The purpose of this study was to evaluate whether patients undergoing primary total hip arthroplasty (THA) at a higher elevation have higher rates of: 1) in-hospital length of stay (LOS); 2) surgical site infections (SSIs); 3) periprosthetic joint infections (PJIs); and 4) costs. Materials and Methods: The Medicare claims database was used to identify patients who underwent primary THA at an altitude higher than 4,000 feet (ft). High-altitude patients were matched to patients who underwent primary THA at an altitude less than 100 ft, yielding 24,958 and 124,765 patients respectively. Outcomes that were assessed included in-hospital LOS, SSIs, PJIs, and costs of care. A P-value less than 0.001 was considered statistically significant. Results: Patients in the study group had significantly longer in-hospital LOS (4 days vs 3 days, P<0.0001). In addition, patients in the study group had a significantly higher incidence and odds of developing SSIs (1.16% vs 0.86%; odds ratio [OR], 1.34; P<0.0001) and PJIs (0.91% vs 0.58%; OR, 1.56; P<0.0001) within 90-days following the index procedure, compared to matched controls. Higher altitude patients incurred higher day of surgery ($16,139.76 vs $15,279.42; P<0.0001) and 90-day costs ($18,647.51 vs $16,401.62; P<0.0001). Conclusion: This study demonstrated that primary THA procedures performed at an elevation higher than 4,000 ft are associated with longer in-hospital LOS, higher rates of SSIs, PJIs, and costs of care. Orthopedists and other healthcare professionals can use this information to provide adequate education for these patients regarding the potential complications that may occur following their procedure.
참고문헌 (19)
- Aasen DM, "Association of hospital altitude and postoperative infectious complications after major operations", High Alt Med Biol, 20, pp.421~426 (2019)
- Hanna JM, "Climate, altitude, and blood pressure", Hum Biol, 71, pp.553~582 (1999)
- Mason NP, "The physiology of high altitude : an introduction to the cardio-respiratory changes occurring on ascent to altitude", Curr Anaesth Crit Care, 11, pp.34~41 (2000)
- Ninivaggi M, "Hypoxia induces a prothrombotic state independently of the physical activity", PLoS One, 10, pp.e0141797~ (2015)
- Bendz B, "Association between acute hypobaric hypoxia and activation of coagulation in human beings", Lancet, 356, pp.1657~1658 (2000)
- Basnyat B, "Infectious diseases at high altitude", Microbiol Spectr, 3 (2015)[DOI]
- Donnally CJ 3rd, "High altitude is an independent risk factor for developing a pulmonary embolism, but not a deep vein thrombosis following a 1-to 2-level lumbar fusion", Global Spine J, 9, pp.729~734 (2019)
- Damodar D, "A higher altitude is an independent risk factor for venous thromboembolisms following total shoulder arthroplasty", J Orthop, 15, pp.1017~1021 (2018)
- Damodar D, "A higher altitude is an independent risk factor for venous thromboembolisms after total hip arthroplasty", J Arthroplasty, 33, pp.2627~2630 (2018)
- Cancienne JM, "High altitude is an independent risk factor for postoperative symptomatic venous thromboembolism after knee arthroscopy : a matched casecontrol study of Medicare patients", Arthroscopy, 33, pp.422~427 (2017)
- Murphy WS, "2018 John Charnley Award : analysis of US hip replacement Bundled Payments : physician-initiated episodes Outperform hospital-initiated episodes", Clin Orthop Relat Res, 477, pp.271~280 (2019)
- Navathe AS, "Association of hospital participation in a medicare Bundled Payment program with volume and case mix of lower extremity joint replacement episodes", JAMA, 320, pp.901~910 (2018)
- Horn SR, "Clinical impact and economic burden of hospital-acquired conditions following common surgical procedures", Spine(Phila Pa 1976), 43, pp.E1358~E1363 (2018)
- Arefian H, "Extra length of stay and costs because of health care-associated infections at a German university hospital", Am J Infect Control, 44, pp.160~166 (2016)
- Whitehouse JD, "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, 23, pp.183~189 (2002)
- Singh GK, "Is high altitude a risk factor in development of herpes zoster", High Alt Med Biol, 19, pp.244~248 (2018)
- Saeed MJ, "Procedurespecific surgical site infection incidence varies widely within certain National Healthcare Safety Network surgery groups", Am J Infect Control, 43, pp.617~623 (2015)
- Blumberg TJ, "Predictors of increased cost and length of stay in the treatment of postoperative spine surgical site infection", Spine J, 18, pp.300~306 (2018)
- Molloy IB, "Effects of the length of stay on the cost of total knee and total hip arthroplasty from 2002 to 2013", J Bone Joint Surg Am, 99, pp.402~407 (2017)