Abstract
BackgroundThis study assessed incidence, risk factors, and outcomes of Staphylococcus aureus infections (SAI) following endoprosthetic hip or knee, or spine surgeries.MethodsAdult patients with at least one of the selected surgeries from 2012 to 2015 captured in a German sickness fund database were included. SAI were identified using S. aureus-specific ICD-10 codes. Patients with certain prior surgeries and infections were excluded. Cumulative incidence and incidence density of post-surgical SAI were assessed. Risk factors, mortality, healthcare resource utilization and direct costs were compared between SAI and non-SAI groups using multivariable analyses over the 1 year follow-up.ResultsOverall, 74,327 patients who underwent a knee (28.6%), hip (39.6%), or spine surgery (31.8%) were included. The majority were female (61.58%), with a mean age of 69.59 years and a mean Charlson Comorbidity Index (CCI) of 2.3. Overall, 1.92% of observed patients (20.20 SAI per 1000 person-years (PY)) experienced a SAI within 1 year of index hospitalization. Knee surgeries were associated with lower SAI risk compared with hip surgeries (Hazard Ratio (HR) = 0.8; p = 0.024), whereas spine surgeries did not differ significantly from hip surgeries. Compared with non-SAI group, the SAI group had on average 4.4 times the number of hospitalizations (3.1 vs. 0.7) and 7.7 times the number of hospital days (53.5 vs. 6.9) excluding the index hospitalization (p < 0.001). One year post-orthopedic mortality was 22.38% in the SAI and 5.31% in the non-SAI group (p < 0.001). The total medical costs were significantly higher in the SAI group compared to non-SAI group (42,834€ vs. 13,781€; p < 0.001). Adjusting for confounders, the SAI group had nearly 2 times the all-cause direct healthcare costs (exp(b) = 1.9; p < 0.001); and 1.72 times higher risk of death (HR = 1.72; p < 0.001).ConclusionsSAI risk after orthopedic surgeries persists and is associated with significant economic burden and risk of mortality. Hence, risk reduction and prevention methods are of utmost importance.
Highlights
This study assessed incidence, risk factors, and outcomes of Staphylococcus aureus infections (SAI) following endoprosthetic hip or knee, or spine surgeries
Patients were excluded based on the following criteria: (i) age < 18 years at index date; (ii) any other surgery in the 180 days before index date; (iii) any surgery performed on the same part of the body as the index surgery in the 365 days baseline period before index date; (iv) any SAI documented in the 90 days before index date; and (v) more than one type of surgery of interest during the index hospitalization
The length of stay for index hospitalization was 14.07 days (SD: 9.12); 5.78% of patients experienced complications of prosthetic devices and implants during index hospitalization and 5.50% had bacterial infections caused by pathogens other than Staphylococci during their index hospitalization
Summary
This study assessed incidence, risk factors, and outcomes of Staphylococcus aureus infections (SAI) following endoprosthetic hip or knee, or spine surgeries. Postoperative surgical site infections (SSIs) are associated with increased morbidity and mortality, decreased quality of life for patients [1,2,3,4], and higher hospitalization costs compared with surgery patients without such infections [4,5,6]. Previous studies have found 20% of SSIs are Staphylococcus aureus (S. aureus), making it the most. This study sought to further understand the incidence, risk factors and clinical and economic outcomes of SAI following orthopedic surgeries using a large German claims dataset
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
