Comparative Analysis of Periprosthetic Joint Infection Rates After Total Hip Arthroplasty Across Facility Types: A Single Institution Study.

Abstract

As the surgical volume of total hip arthroplasty (THA) has grown, there has been a concomitant shift away from performing this procedure in traditional, inpatient facilities towards various outpatient centers. Several studies have investigated rates of surgical site and periprosthetic joint infections (PJI) among patients undergoing common orthopaedic procedures stratified by facility type. However, there is a paucity of studies comparing PJI rates after THA performed in tertiary hospital centers (THC), community hospitals (CH), orthopaedic specialty hospitals (OSH), and ambulatory surgical centers (ASC) associated with a single health system. Patients who underwent primary, elective THA from 2017 to 2024 were retrospectively identified and stratified into cohorts depending on facility type. There were 39,743 patients identified (THC: 16,286, CH: 11,314, OSH: 10,891, ASC: 1,252). Data regarding demographics, surgical variables, surgical outcomes, and PJIs were collected. Statistical analyses were performed to compare groups. Multivariable Cox regressions were performed to identify predictors of PJI. The overall PJI rates across all facilities were 1.07%, and there were no differences in overall PJI rates between groups. Multivariable regressions controlling for facility type, age, sex, body mass index, Charlson Comorbidity Index, operating room time, and surgeon experience demonstrated that none of the facility types were associated with greater odds of developing PJI after THA. The THAs performed at different facility types have similar rates of postoperative PJIs. THAs performed at ASCs and THCs had similar odds of PJI. Surgeons may therefore perform THAs at various outpatient centers without sustaining an increased risk for PJI.