Prevalence of modifiable risk factors in primary elective arthroplasty and their association with infections

• Published in: Acta Orthopaedica
• Main Authors: Sigurðardóttir, María, Sigurðsson, Martin Ingi, Ólafsson, Yngvi, Sverrisdóttir, Sólveig Hólmfr, Gunnarsdóttir, Ingibjörg, Sigurðsson, Emil Lárus, Kárason, Sigurbergur
• Other Authors: Other departments, Faculty of Medicine, Surgical Services, Faculty of Food Science and Nutrition
• Format: Article in Journal/Newspaper
• Language: English
• Published: 2023
• Subjects: Svæfinga- og gjörgæslulæknisfræði; Bæklunarskurðlæknisfræði; Næringarfræðingar; Aged; Female; Humans; Arthroplasty; Replacement; Hip/adverse effects; Knee/adverse effects; Glycated Hemoglobin; Obesity/complications; Prevalence; Prosthesis-Related Infections/epidemiology; Retrospective Studies; Risk Factors; Male; Middle Aged; Medicine (all); Surgery; Iceland
• Online Access: https://hdl.handle.net/20.500.11815/4175; https://doi.org/10.2340/17453674.2023.8480

Funding Information: The study was approved by the Science Committee of the Capital area’s Primary Care and University of Iceland and by the Icelandic National Bioethics Committee (case number: VSN-18-098) and is registered at ClinicalTrials. gov (NCT05399186). This study was supported by grants from Landspitali Research Fund (A-2019-056, A-202-042, A-2021-036) and Research fund of Sigridur Larusdottir by University of Iceland. Data sharing is possible after reasonable request. The authors declare no conflict of interest. Completed disclosure forms for this article following the ICMJE template are available on the article page, doi:10.2340/17453674.2023.8480 Publisher Copyright: © 2023 The Author(s). Background and purpose — The aim of this study was to identify the prevalence of modifiable risk factors of surgical site infections (SSI) in patients undergoing primary elective total joint arthroplasty (TJA) receiving conventional preoperative preparation, and to explore their association with infectious outcomes. Patients and methods — Information regarding modifiable risk factors (anemia, diabetes, obesity, nutritional status, smoking, physical activity) was prospectively gath-ered in patients undergoing primary TJA of hip or knee in 2018–2020 at a single institution with 6 weeks’ follow-up time. Results — 738 patients (median age 68 years [IQR 61–73], women 57%) underwent TJA (knee 64%, hip 36%). Anemia was detected in 8%, diabetes was present in 9%, an additional 2% had undiagnosed diabetes (HbA1c > 47 mmol/mol), and 8% dysglycemia (HbA1c 42–47 mmol/mol). Obesity (BMI ≥ 30) was observed in 52%. Serum albumin, total lymphocyte count, and vitamin D below normal limits was identified in 0.1%, 18%, and 16%, respectively. Current smokers were 7%. Surgical site complications occurred in 116 (16%), superficial SSI in 57 (8%), progressing to periprosthetic joint infection in 7 cases. Univariate analysis identified higher odds of superficial SSI for BMI ≥ 30 (OR 2.1, 95%CI 1.2–3.8) and HbA1c ≥ 42 mmol/mol (OR 2.2, ...