CoxaPro
> Clinical Library > Welcome to the joint replacement clinical library > Periprosthetic joint infection after primary TKA in the medicare population: How frequently are patients revised at a different hospital?
The Knee, ISSN: 0968-0160, Vol: 31, Page: 172-179
Knee
Link to article
Periprosthetic joint infection after primary TKA in the medicare population: How frequently are patients revised at a different hospital?
Keely Boyle, K; Landy, David C; Kapadia, Milan; Chalmers, Brian P; Miller, Andy O; Cross, Michael BKnee
Background
Periprosthetic infection (PJI) after total knee arthroplasty (TKA) places a significant burden on hospitals. We sought to describe the proportion of patients undergoing revision for PJI at a different hospital within one year of primary TKA and whether patient characteristics or hospital volume were associated with this change.
Methods
Medicare data from 2005 to 2014 was retrospectively reviewed using PearlDiver. All patients over 64 years undergoing revision for PJI within one year of primary TKA were stratified by the revision occurring within 90 days. Hospitals were grouped by annual TKA volume as Low (<50), Medium (51–100), High (101–200), and Very High (>200). Associations of patient characteristics and hospital volume with revision at a different hospital were assessed using Chi-squared tests and Somers’ D.
Results
Of 8,337 patients undergoing revision within 90 days of TKA, 1,370 (16%) were revised at a different hospital. Changing hospitals was associated with having primary TKA at a lower volume hospital (24% for low, 15% medium, 12% high, and 12% very high; P < 0.001). Of 7,608 patients undergoing revision between 91 and 365 days, 1,110 (15%) were revised at a different hospital. Changing hospitals was associated with having primary TKA at a lower volume hospital (26% for low, 14% medium, 10% high, and 9% very high; P < 0.001). Changing hospitals was not associated with sex or age.
Conclusion
Patients frequently undergo revision for PJI at a different hospital, even within 90 days of TKA. Further research is needed to understand these implications of this care pathway shift.
Link to article