Preoperative Sepsis Is Associated with an Elevated Rate of Periprosthetic Joint Infection and Mortality Following Total Hip Arthroplasty in a Time-Dependent Manner.

Abstract

Patients who have sepsis often experience persistent immune system and physiological dysregulation. However, the impact of preoperative sepsis on outcomes following elective total hip arthroplasty (THA) remains poorly defined. Thus, the purpose of this study was to evaluate the impact of preoperative sepsis on medical and surgical complications following primary THA, with attention to timing and etiology of sepsis in relation to adverse outcomes at 90 days and two years postoperatively. A retrospective cohort study was performed using a national insurance database. Patients diagnosed with sepsis within two years prior to THA were propensity score matched 1:3 to controls. Sepsis was stratified by timing (less than three months, three to six months, six to 12 months, 12 to 18 months, and 18 to 24 months preoperatively) and by etiology. Medical and surgical complications were assessed at 90 days and two years. Statistical significance was set at P < 0.05. Preoperative sepsis was associated with increased 90-day rates of periprosthetic joint infection (odds ratio (OR) 1.4), postoperative sepsis (OR 3.6), acute kidney injury (OR 1.4), urinary tract infection (OR 1.8), pneumonia (OR 2.1), readmission (OR 1.3), and wound dehiscence (OR 1.4). At two years, rates of periprosthetic joint infection (OR 1.4), dislocation (OR 1.3), and mortality (OR 1.5) were elevated. Acute kidney injury, deep vein thrombosis, and readmission were increased when sepsis occurred within six months of THA, whereas periprosthetic joint infection and mortality remained elevated when sepsis occurred within one year. Gram-positive sepsis was associated with prosthetic joint infection (OR 2.1) and periprosthetic fracture (OR 1.8), while Gram-negative sepsis was associated with urinary tract infection (OR 2.6) (all findings P < 0.05). Sepsis within two years prior to THA was associated with increased medical and surgical complications, with time-dependent risk patterns influencing postoperative outcomes.