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J Knee Surg 2024; 37(07): 530-537
DOI: 10.1055/s-0043-1777788
Original Article

How Many Patients Qualify for Extended Oral Antibiotic Prophylaxis Infection Following Primary and Revision Hip and Knee Arthroplasties?

Genna R. Potter
1   Department of Orthopedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
,
Bennett W. Feuchtenberger
2   Department of Orthopedic Surgery, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
,
Halee N. Sowinski
3   Department of Orthopaedics, West Virginia University School of Medicine, Morgantown, West Virginia
,
Austin J. Roberts
3   Department of Orthopaedics, West Virginia University School of Medicine, Morgantown, West Virginia
,
Eric R. Siegel
4   Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
,
Matthew J. Dietz
3   Department of Orthopaedics, West Virginia University School of Medicine, Morgantown, West Virginia
,
Jeffery B. Stambough 
1   Department of Orthopedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
,
Nicholas A. Bedard
5   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Simon C. Mears
1   Department of Orthopedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Abstract

Extended oral antibiotic prophylaxis (EOAP) has been suggested to reduce rates of periprosthetic joint infection (PJI) postoperatively after total joint arthroplasty (TJA). The purpose of this multicenter study is to define how many TJA patients are considered high risk for developing PJI based on published EOAP criteria and determine whether this status is associated with socioeconomic or demographic factors. All primary and aseptic revision TJAs performed in 2019 at three academic medical centers were reviewed. High-risk status was defined based on prior published EOAP criteria. Area deprivation index (ADI) was calculated as a measure of socioeconomic status. Data were reported as means with standard deviation. Both overall and institutional differences were compared. Of the 2,511 patients (2,042 primary and 469 revision) in this cohort, 73.3% met criteria for high risk (primary: 72.9% [1,490] and revision: 74.6% [350]). Patient's race or age did not have a significant impact on risk designation; however, a larger proportion of high-risk patients were women (p = 0.002) and had higher Elixhauser scores (p < 0.001). The mean ADI for high-risk patients was higher (more disadvantaged) than for standard-risk patients (64.0 [20.8] vs. 59.4 [59.4]) (p < 0.001). Over 72% of primary and revision TJA patients at three medical centers met published criteria for EOAP. These patients were more often women, had more comorbidities, and lived in more disadvantaged areas. Our findings suggest that most patients qualify for EOAP, which may call for more stringent criteria on who would benefit extended antibiotic prophylaxis.

Keywords

extended oral antibiotic prophylaxis - area deprivation index - total joint arthroplasty - prosthetic joint infection - high risk


Publication History

Received: 30 August 2023

Accepted: 18 November 2023

Article published online:
15 December 2023

© 2023. Thieme. All rights reserved.

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