Moderating effects of immunosuppressive medications and risk factors for post-operative joint infection following total joint arthroplasty in patients with rheumatoid arthritis or osteoarthritis

Elizabeth Salt, Amanda T. Wiggins, Mary Kay Rayens, Brent J. Morris, David Mannino, Andrew Hoellein, Ryan P. Donegan, Leslie J. Crofford

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

Objective Inconclusive findings about infection risks, importantly the use of immunosuppressive medications in patients who have undergone large-joint total joint arthroplasty, challenge efforts to provide evidence-based perioperative total joint arthroplasty recommendations to improve surgical outcomes. Thus, the aim of this study was to describe risk factors for developing a post-operative infection in patients undergoing TJA of a large joint (total hip arthroplasty, total knee arthroplasty, or total shoulder arthroplasty) by identifying clinical and demographic factors, including the use of high-risk medications (i.e., prednisone and immunosuppressive medications) and diagnoses [i.e., rheumatoid arthritis (RA), osteoarthritis (OA), gout, obesity, and diabetes mellitus] that are linked to infection status, controlling for length of follow-up. Methods A retrospective, case-control study (N = 2212) using de-identified patient health claims information from a commercially insured, U.S. dataset representing 15 million patients annually (from January 1, 2007 to December 31, 2009) was conducted. Descriptive statistics, t-test, chi-square test, Fisher's exact test, and multivariate logistic regression were used. Results Male gender (OR = 1.42, p < 0.001), diagnosis of RA (OR = 1.47, p = 0.031), diabetes mellitus (OR = 1.38, p = 0.001), obesity (OR = 1.66, p < 0.001) or gout (OR = 1.95, p = 0.001), and a prescription for prednisone (OR = 1.59, p < 0.001) predicted a post-operative infection following total joint arthroplasty. Persons with post-operative joint infections were significantly more likely to be prescribed allopurinol (p = 0.002) and colchicine (p = 0.006); no significant difference was found for the use of specific disease-modifying anti-rheumatic drugs and TNF-α inhibitors. Conclusion High-risk, post-operative joint infection groups were identified allowing for precautionary clinical measures to be taken.

Original languageEnglish
Pages (from-to)423-429
Number of pages7
JournalSeminars in Arthritis and Rheumatism
Volume46
Issue number4
DOIs
StatePublished - Feb 1 2017

Bibliographical note

Funding Information:
This work was supported in part by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, United States (UL1TR000117). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Access to the large commercially insured dataset was made available with funding from CTSA UL1TR000117.

Publisher Copyright:
© 2017 Elsevier Inc.

Keywords

  • Case–control study
  • Immunosuppressive medications
  • Infections
  • Perioperative management
  • Risk factors
  • Total joint arthroplasty

ASJC Scopus subject areas

  • Rheumatology
  • Anesthesiology and Pain Medicine

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