Mortality and adverse joint outcomes following septic arthritis of the native knee: a longitudinal cohort study of patients receiving arthroscopic washout

被引:61
作者
Abram, Simon G. F. [1 ,2 ]
Alvand, Abtin [1 ]
Judge, Andrew [1 ,2 ,3 ,4 ]
Beard, David J. [1 ,2 ]
Price, Andrew J. [1 ,2 ]
机构
[1] Univ Oxford, Nuffield Dept Orthopaed Rheumatol & Musculoskelet, Oxford OX3 7LD, England
[2] NIHR, Biomed Res Ctr, Oxford OX3 7LD, England
[3] Univ Bristol, Musculoskeletal Res Unit, Bristol, Avon, England
[4] NIHR Biomed Res Ctr, Bristol, Avon, England
关键词
COMORBIDITY; PREVALENCE; MANAGEMENT; ENGLAND;
D O I
10.1016/S1473-3099(19)30419-0
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background The short-term and long-term consequences of septic arthritis are uncertain. We aimed to determine risk of mortality and adverse joint outcomes following septic arthritis of the native knee. Methods We did a retrospective cohort study in patients who received arthroscopic knee washout for septic arthritis in England between April 1, 1997, and March 31, 2017, using data in the national Hospital Episode Statistics database. Patients with previous knee surgery to the same knee were excluded. Mortality within 90 days, adverse joint outcomes (arthrodesis, amputation, arthroplasty) within 1 year, and arthroplasty within 15 years were determined. Mortality in patients with a primary admitting diagnosis of septic arthritis (ICD-10) was compared with that in patients in whom septic arthritis was a secondary diagnosis. Findings 12132 patients were included (mean age 56.6 years [SD 24.9]) of whom 4307 (36%) were female. In 10195 (84%) patients with septic arthritis as the primary admitting diagnosis, 90-day mortality was 7.05% (95% CI 6. 56-7. 57; 719 patients), rising to 22.69% (20. 80-24. 68; 418 patients) in 1842 patients older than 79 years. Secondary septic arthritis diagnosis versus primary diagnosis was associated with an adjusted odds ratio for mortality of 2.10 (95% CI 1.79-2.46; p<0.0001). In 11393 patients with at least 1 year follow-up, the 1 year rates were 0.13% (95% CI 0.07-0.22; 15 patients) for arthrodesis, 0.40% (0.30-0.54; 46 patients) for amputation, and 1.33%; (1.13-1.56; 152 patients) for arthroplasty. Within 15 years, 159 (8.76%; 95% CI 7.50-10.15) of 1816 patients had received arthroplasty, corresponding to an annual risk of arthroplasty that was about six times that of the general population (risk ratio 6.14, 95% CI 4.95-7.62; p<0.0001). Interpretation The consequences of septic knee arthritis in patients undergoing arthroscopic knee washout are serious. These findings highlight the potentially devastating outcomes associated with sepsis from musculoskeletal joint infection. Copyright (C) 2019 Elsevier Ltd. All rights reserved.
引用
收藏
页码:341 / 349
页数:9
相关论文
共 41 条
[1]   Adverse outcomes after arthroscopic partial meniscectomy: a study of 700 000 procedures in the national Hospital Episode Statistics database for England [J].
Abram, Simon G. F. ;
Judge, Andrew ;
Beard, David J. ;
Price, Andrew J. .
LANCET, 2018, 392 (10160) :2194-2202
[2]  
[Anonymous], 2017, SUMM HOSP LEV MORT I
[3]  
[Anonymous], 2017, NAT CLIN COD STAND
[4]  
[Anonymous], ANN RHEUM DIS S3
[5]  
[Anonymous], 2004, CRIT CARE MED
[6]  
APHO, 2010, COMM US PUBL HLTH ST
[7]   Epidemiology and Management of Acute, Uncomplicated Septic Arthritis and Osteomyelitis Spanish Multicenter Study [J].
Calvo, Cristina ;
Nunez, Esmeralda ;
Camacho, Marisol ;
Clemente, Daniel ;
Fernandez-Cooke, Elisa ;
Alcobendas, Rosa ;
Mayol, Luis ;
Soler-Palacin, Pere ;
Oscoz, Miren ;
Saavedra-Lozano, Jesus .
PEDIATRIC INFECTIOUS DISEASE JOURNAL, 2016, 35 (12) :1288-1293
[8]   A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION [J].
CHARLSON, ME ;
POMPEI, P ;
ALES, KL ;
MACKENZIE, CR .
JOURNAL OF CHRONIC DISEASES, 1987, 40 (05) :373-383
[9]   A comparison of the recording of comorbidity in primary and secondary care by using the Charlson Index to predict short-term and long-term survival in a routine linked data cohort [J].
Crooks, C. J. ;
West, J. ;
Card, T. R. .
BMJ OPEN, 2015, 5 (06)
[10]   Treatment of early septic arthritis of the hip in children: comparison of results of open arthrotomy versus arthroscopic drainage [J].
El-Sayed, Ahmed Mounir Moustafa .
JOURNAL OF CHILDRENS ORTHOPAEDICS, 2008, 2 (03) :229-237