Skip to main content
×
×
Home

The Mayo Prosthetic Joint Infection Risk Score: Implication for Surgical Site Infection Reporting and Risk Stratification

  • Elie F. Berbari (a1) (a2), Douglas R. Osmon (a1), Brian Lahr (a3), Jeanette E. Eckel-Passow (a3), Geoffrey Tsaras (a1) (a4), Arlen D. Hanssen (a5), Tad Mabry (a5), James Steckelberg (a1) and Rodney Thompson (a2)...
Abstract
Objective.

The goal of this study was to develop a prognostic scoring system for the development of prosthetic joint infection (PJI) that could risk-stratify patients undergoing total hip (THA) or total knee (TKA) arthroplasties.

Design.

Previously reported case-control study.

Setting.

Tertiary referral care setting from 2001 through 2006.

Methods.

A derivation data set of 339 cases and 339 controls was used to develop 2 scores. A baseline score and a 1-month-postsurgery risk score were computed as a function of the relative contributions of risk factors for each model. Points were assigned for the presence of each factor and then summed to get a subject's risk score.

Results.

The following risk factors were detected from multivariable modeling and incorporated into the baseline Mayo PJI risk score: body mass index, prior other operation on the index joint, prior arthroplasty, immunosuppression, ASA score, and procedure duration (c index, 0.722). The 1-month-postsurgery risk score contained the same variables in addition to postoperative wound drainage (c index, 0.716).

Conclusion.

The baseline score might help with risk stratification in relation to public reporting and reimbursement as well as targeted prevention strategies in patients undergoing THA or TKA. The application of the 1-month-postsurgery PJI risk score to patients undergoing THA or TKA might benefit those undergoing workup for PJI.

Copyright
Corresponding author
Division of Infectious Diseases, Mayo Clinic, 200 First SW, Rochester, MN 55905 (berbari.elie@mayo.edu)
References
Hide All
1.Kurtz, S, Ong, K, Lau, E, Mowat, F, Halpern, M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Jt Surg (Am) 2007;89(4): 780785.
2.Mahomed, NN, Barrett, JA, Katz, JN, et al. Rates and outcomes of primary and revision total hip replacement in the United States Medicare population. J Bone Jt Surg (Am) 2003;85(1):2732.
3.Kurtz, SM, Lau, E, Schmier, J, Ong, KL, Zhao, K, Parvizi, J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty 2008;23(7): 984991.
4.Sculco, TP. The economic impact of infected joint arthroplasty. Orthopedics 1995;18(9): 871873.
5.Berbari, EF, Marculescu, C, Sia, I, et al. Culture-negative prosthetic joint infection. Clin Infect Dis 2007;45(9): 11131119.
6.Zimmerli, W, Trampuz, A, Ochsner, PE. Prosthetic-joint infections. New Engl J Med 2004;351(16): 16451654.
7.Mu, Y, Edwards, JR, Horan, TC, Berrios-Torres, SI, Fridkin, SK. Improving risk-adjusted measures of surgical site infection for the national healthcare safety network. Infect Control Hosp Epidemiol 2011;32(10): 970986.
8.Berbari, EF, Hanssen, AD, Duffy, MC, et al. Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis 1998;27(5):12471254.
9.Kurtz, SM, Ong, KL, Lau, E, Bozic, KJ, Berry, D, Parvizi, J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res 2010;468(1):5256.
10.Saleh, MO, Olson, M, Resig, S, et al. Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program. J Orthop Res 2002;20(3): 506515.
11.Webb, BG, Lichtman, DM, Wagner, RA. Risk factors in total joint arthroplasty: comparison of infection rates in patients with different socioeconomic backgrounds. Orthopedics 2008;31(5):445.
12.Berbari, EF, Osmon, DR, Carr, A, et al. Dental procedures as risk factors for prosthetic hip or knee infection: a hospital-based prospective case-control study. Clin Infect Dis 2010;50(1): 816.
13.Pulido, L, Ghanem, E, Joshi, A, Purtill, JJ, Parvizi, J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 2008;466(7): 17101715.
14.Ong, KL, Lau, E, Manley, M, Kurtz, SM. Effect of procedure duration on total hip arthroplasty and total knee arthroplasty survivorship in the United States Medicare population. J Arthroplasty 2008;23(suppl 6):127132.
15.Poss, R, Thornhill, TS, Ewald, FC, Thomas, WH, Batte, NJ, Sledge, CB. Factors influencing the incidence and outcome of infection following total joint arthroplasty. Clin Orthop Relat Res 1984;182:117126.
16.Geubbels, EL, Grobbee, DE, Vandenbroucke-Grauls, CM, Wille, JC, de Boer, AS. Improved risk adjustment for comparison of surgical site infection rates. Infect Control Hosp Epidemiol 2006;27(12):13301339.
17.DeLong, ER, DeLong, DM, Clarke-Pearson, DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988;44(3):837845.
18.Al-Sarraf, N, Raza, A, Rowley, S, et al. Short-term and long-term outcome in low body mass index patients undergoing cardiac surgery. Gen Thorac Cardiovasc Surg 2009;57(2): 8793.
19.Jensen, JE, Jensen, TG, Smith, TK, Johnston, DA, Dudrick, SJ. Nutrition in orthopaedic surgery. J Bone Jt Surg (Am) 1982;64(9):12631272.
20.Ji, GW, Wu, YZ, Wang, X, et al. Experimental and clinical study of influence of high-frequency electric surgical knives on healing of abdominal incision. World J Gastroenterol 2006;12(25): 40824085.
21.Bozic, KJ, Smith, AR, Mauerhan, DR. Pay-for-performance in orthopedics: implications for clinical practice. J Arthroplasty 2007;22(suppl 6):812.
22.Centers for Medicare and Medicaid Services. CMS 2009 final inpatient payment rule. http://www.cms.hhs.gov/AcuteInpatientPPS/downloads/CMS-1390-F.pdf. Accessed October 29, 2011.
23.Centers for Disease Control and Prevention, National Center for Preparedness, Detection and Control of Infectious Diseases, Division of Healthcare Quality Promotion. The National Healthcare Safety Network (NHSN) manual: patient safety component protocol, http://www.cdc.gov/nhsn/PDFs/pscManual/pscManual_current.pdf.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 1
Total number of PDF views: 88 *
Loading metrics...

Abstract views

Total abstract views: 694 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 19th July 2018. This data will be updated every 24 hours.