The projected burden of complex surgical site infections following hip and knee arthroplasties in adults in the United States, 2020 through 2030

AbstractBackgroundAs the US population ages, the number of hip and knee arthroplasties is expected to increase. Because surgical site infections (SSIs) following these procedures contribute substantial morbidity, mortality, and costs, we projected SSIs expected to occur from 2020 through 2030.MethodsWe used a stochastic Poisson process to project the number of primary and revision arthroplasties and SSIs. Primary arthroplasty rates were calculated using annual estimates of hip and knee arthroplasty stratified by age and gender from the 2012–2014 Nationwide Inpatient Sample and standardized by census population data. Revision rates, dependent on time from primary procedure, were obtained from published literature and were uniformly applied for all ages and genders. Stratified complex SSI rates for arthroplasties were obtained from 2012–2015 National Healthcare Safety Network data. To evaluate the possible impact of prevention measures, we recalculated the projections with an SSI rate reduced by 30%, the national target established by the US Department of Health and Human Services (HHS).ResultsWithout a reduction in SSI rates, we projected an increase in complex SSIs following hip and knee arthroplasty of 14% between 2020 and 2030. We projected a total burden of 77,653 SSIs; however, meeting the 30% rate reduction could prevent 23,297 of these SSIs.ConclusionsGiven current SSI rates, we project that complex SSI burden for primary and revision arthroplasty may increase due to an aging population. Reducing the SSI rate to the national HHS target could prevent 23,000 SSIs and reduce subsequent morbidity, mortality, and Medicare costs.

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Arthroplasty Utilization in the United States is Predicted by Age-Specific Population Groups

ISRN Orthopedics ◽

10.5402/2012/185938 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 21

Author(s):

Bronislava Bashinskaya ◽

Ryan M. Zimmerman ◽

Brian P. Walcott ◽

Valentin Antoci

Keyword(s):

United States ◽

Knee Arthroplasty ◽

Population Group ◽

Population Data ◽

The United States ◽

Census Bureau ◽

Linear Regression Models ◽

United States Census ◽

United States Census Bureau ◽

Hip And Knee Arthroplasty

Osteoarthritis is a common indication for hip and knee arthroplasty. An accurate assessment of current trends in healthcare utilization as they relate to arthroplasty may predict the needs of a growing elderly population in the United States. First, incidence data was queried from the United States Nationwide Inpatient Sample from 1993 to 2009. Patients undergoing total knee and hip arthroplasty were identified. Then, the United States Census Bureau was queried for population data from the same study period as well as to provide future projections. Arthroplasty followed linear regression models with the population group >64 years in both hip and knee groups. Projections for procedure incidence in the year 2050 based on these models were calculated to be 1,859,553 cases (hip) and 4,174,554 cases (knee). The need for hip and knee arthroplasty is expected to grow significantly in the upcoming years, given population growth predictions.

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Projected Burden of Complex Surgical Site Infections following Total Hip and Knee Arthroplasty among Adults in the United States, 2020 through 2030

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1744 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S654-S655

Author(s):

Hannah Wolford ◽

Kelly Hatfield ◽

Prabasaj Paul ◽

Sarah Yi ◽

John A Jernigan ◽

...

Keyword(s):

United States ◽

Knee Arthroplasty ◽

Surgical Site Infections ◽

The United States ◽

Total Hip ◽

Hip And Knee Arthroplasty

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Engagement with COVID-19 Public Health Measures in the United States: A Cross-Sectional Social Media Analysis from June to November 2020 (Preprint)

10.2196/preprints.26655 ◽

2020 ◽

Author(s):

Daisy Massey ◽

Chenxi Huang ◽

Yuan Lu ◽

Alina Cohen ◽

Yahel Oren ◽

...

Keyword(s):

Public Health ◽

Social Media ◽

Language Processing ◽

Daily Life ◽

The United States ◽

Media Analysis ◽

Prevention Measures ◽

Cross Sectional ◽

Health Measures ◽

The Us

BACKGROUND The coronavirus disease 2019 (COVID-19) has continued to spread in the US and globally. Closely monitoring public engagement and perception of COVID-19 and preventive measures using social media data could provide important information for understanding the progress of current interventions and planning future programs. OBJECTIVE To measure the public’s behaviors and perceptions regarding COVID-19 and its daily life effects during the recent 5 months of the pandemic. METHODS Natural language processing (NLP) algorithms were used to identify COVID-19 related and unrelated topics in over 300 million online data sources from June 15 to November 15, 2020. Posts in the sample were geotagged, and sensitivity and specificity were both calculated to validate the classification of posts. The prevalence of discussion regarding these topics was measured over this time period and compared to daily case rates in the US. RESULTS The final sample size included 9,065,733 posts, 70% of which were sourced from the US. In October and November, discussion including mentions of COVID-19 and related health behaviors did not increase as it had from June to September, despite an increase in COVID-19 daily cases in the US beginning in October. Additionally, counter to reports from March and April, discussion was more focused on daily life topics (69%), compared with COVID-19 in general (37%) and COVID-19 public health measures (20%). CONCLUSIONS There was a decline in COVID-19-related social media discussion sourced mainly from the US, even as COVID-19 cases in the US have increased to the highest rate since the beginning of the pandemic. Targeted public health messaging may be needed to ensure engagement in public health prevention measures until a vaccine is widely available to the public.

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Infection Burden for Hip and Knee Arthroplasty in the United States

The Journal of Arthroplasty ◽

10.1016/j.arth.2007.10.017 ◽

2008 ◽

Vol 23 (7) ◽

pp. 984-991 ◽

Cited By ~ 604

Author(s):

Steven M. Kurtz ◽

Edmund Lau ◽

Jordana Schmier ◽

Kevin L. Ong ◽

Ke Zhao ◽

...

Keyword(s):

United States ◽

Knee Arthroplasty ◽

The United States ◽

Hip And Knee Arthroplasty

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Development of antibiotic resistance in periprosthetic joint infection after total knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.103b6.bjj-2020-1923.r1 ◽

2021 ◽

Vol 103-B (6 Supple A) ◽

pp. 171-176

Author(s):

Antonio Klasan ◽

Arne Schermuksnies ◽

Florian Gerber ◽

Matt Bowman ◽

Susanne Fuchs-Winkelmann ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Antibiotic Resistance ◽

Knee Arthroplasty ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Bacterial Strains ◽

Coagulase Negative Staphylococci ◽

Primary Arthroplasty ◽

Total Knee

Aims The management of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is challenging. The correct antibiotic management remains elusive due to differences in epidemiology and resistance between countries, and reports in the literature. Before the efficacy of surgical treatment is investigated, it is crucial to analyze the bacterial strains causing PJI, especially for patients in whom no organisms are grown. Methods A review of all revision TKAs which were undertaken between 2006 and 2018 in a tertiary referral centre was performed, including all those meeting the consensus criteria for PJI, in which organisms were identified. Using a cluster analysis, three chronological time periods were created. We then evaluated the antibiotic resistance of the identified bacteria between these three clusters and the effectiveness of our antibiotic regime. Results We identified 129 PJIs with 161 culture identified bacteria in 97 patients. Coagulase-negative staphylococci (CNS) were identified in 46.6% cultures, followed by Staphylococcus aureus in 19.8%. The overall resistance to antibiotics did not increase significantly during the study period (p = 0.454). However, CNS resistance to teicoplanin (p < 0.001), fosfomycin (p = 0.016), and tetracycline (p = 0.014) increased significantly. Vancomycin had an 84.4% overall sensitivity and 100% CNS sensitivity and was the most effective agent. Conclusion Although we were unable to show an overall increase in antibiotic resistance in organisms that cause PJI after TKA during the study period, this was not true for CNS. It is concerning that resistance of CNS to new antibiotics, but not vancomycin, has increased in a little more than a decade. Our findings suggest that referral centres should continuously monitor their bacteriological analyses, as these have significant implications for prophylactic treatment in both primary arthroplasty and revision arthroplasty for PJI. Cite this article: Bone Joint J 2021;103-B(6 Supple A):171–176.

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Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005 to 2030

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200704000-00012 ◽

2007 ◽

Vol 89 (4) ◽

pp. 780-785 ◽

Cited By ~ 2321

Author(s):

Steven Kurtz ◽

Kevin Ong ◽

Edmund Lau ◽

Fionna Mowat ◽

Michael Halpern

Keyword(s):

United States ◽

Knee Arthroplasty ◽

The United States ◽

Hip And Knee Arthroplasty

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Acute kidney injury following prophylactic flucloxacillin and gentamicin in primary hip and knee arthroplasty

Clinical Kidney Journal ◽

10.1093/ckj/sfaa059 ◽

2020 ◽

Author(s):

Judi Graham ◽

Emma Borthwick ◽

Christopher Hill ◽

Janine Blaney ◽

Nicola Gallagher ◽

...

Keyword(s):

Acute Kidney Injury ◽

Knee Arthroplasty ◽

Prophylactic Antibiotic ◽

Kidney Injury ◽

Binary Logistic Regression ◽

Surgical Site Infections ◽

Ideal Body Weight ◽

High Dose ◽

Binary Logistic Regression Model ◽

Hip And Knee Arthroplasty

Abstract Background Following concerns regarding the emergence of Clostridium difficile infection in 2010, we changed antibiotic prophylaxis in patients undergoing primary hip and knee arthroplasty from cefuroxime to flucloxacillin and single-dose (SD) gentamicin. A subsequent perceived increase in the incidence of post-operative acute kidney injury (AKI) led us to evaluate the AKI incidence between different prophylactic antibiotic regimes used at our centre. Methods We examined the incidence of AKI as defined by Kidney Disease: Improving Global Outcomes criteria in 1588 patients undergoing primary hip or knee arthroplasty from January 2010 to January 2015. Patients received the following prophylactic antibiotic regimes: 8 g flucloxacillin in four divided doses and SD gentamicin 1.5 mg/kg ideal body weight (IBW; maximum dose 120 mg; n = 400), 8 g flucloxacillin alone in four divided doses (n = 400), SD cefuroxime (n = 400), triple-dose (TD) cefuroxime (n = 188) and teicoplanin with SD gentamicin 1.5 mg/kg IBW (n = 200). Results The incidence of AKI was as follows: flucloxacillin and gentamicin (13%); flucloxacillin alone (8.5%); SD cefuroxime (2%); TD cefuroxime (0.5%); and teicoplanin and gentamicin (3%). Of the six patients who developed Stage 3 AKI, all were in the flucloxacillin and gentamicin group. The odds ratio for the development of AKI derived from a binary logistic regression model was highest in the flucloxacillin and gentamicin group [7.79 (95% confidence interval 3.54–17.14), P < 0.0001]. Conclusions Our findings suggest that the use of prophylactic high-dose flucloxacillin and gentamicin should be used with caution in patients undergoing primary hip or knee arthroplasty without a clear advantage in reducing surgical site infections given the association with increased rates of AKI.

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