Assessing the Risk Factors for Surgical Site and Deep Wound Infections Following Hip Arthroscopy: A Nationwide Study of 75,577 Patients.

Abstract

The indications and utilization of hip arthroscopic surgery have increased over the past decade owing to advances in surgical technique. Although generally rare, surgical site infections (SSIs) are among the most common postoperative complications following this procedure. This study used a nationwide database to assess the incidence and risk factors for SSIs following arthroscopic hip surgery. Following a retrospective query of a nationwide administrative claims database for adults (>18 years old) undergoing primary hip arthroscopy from 2010 to 2021, patients were categorized into two cohorts based on whether they did (N = 235) or did not (N = 75,342) develop an SSI within 90 days of surgery. Multivariable logistic regression models were used to calculate odds ratio (OR) of developing SSIs within 90 days following hip arthroscopy, adjusting for age, sex, and comorbidities comprising the Elixhauser Comorbidity Index (ECI). A P value less than 0.05 was considered statistically significant. The overall incidence of SSIs following hip arthroscopy was 0.31%, with no notable change over the study period (P = 0.697). The two cohorts were similar in age (P = 0.0716), sex (P = 0.2959), and geographic location (P = 0.5995). Overall comorbidity burden was markedly higher among patients who did (ECI = 4.1) versus those who did not (ECI = 2.2) develop SSIs (P < 0.0001). Risk factors for SSIs following hip arthroscopy included depression (OR: 2.02, P < 0.0001), preoperative fluid and electrolyte abnormalities (OR: 1.81, P = 0.0001), history of drug abuse (OR: 1.74, P = 0.00098), and coagulopathy (OR: 1.58, P = 0.0312). Substratification demonstrated that morbidly obese patients (≥35.00 kg/m2) were more likely to develop SSIs (OR: 4.52, P < 0.0001) compared with patients of normal body mass index. The overall rate of SSIs is low following hip arthroscopy. Certain patient-specific factors may be associated with SSIs and warrant further understanding to prevent these occurrences. This study may guide careful and intentional patient selection and optimization before hip arthroscopy, in efforts to reduce the rate of this event. Level III.