Paper of the week: Streamlining Hospital Treatment of Prosthetic Joint Infection

Goodson KM, Kee JR, Edwards PK, Novack AJ, Stambough JB, Siegel ER, Barnes CL, Mears SC.
J Arthroplasty 2020 Mar;35(3S):S63-S68. doi: 10.1016/j.arth.2019.10.056

Summary by Mohammad S Abdelaal MD, MSc

While concerted national efforts have been made to streamline primary hip and knee arthroplasty to short-stay episodes of care as a form of cost containment and value-based care [1, 2], little formal effort has been made to decrease the length of stay in PJI patients. Following surgical management for PJI, patients are routinely admitted to the hospital for monitored administration of IV pathogen-specific antibiotic which is adjusted based on the finalized culture results and respective in vitro susceptibilities. This process frequently takes 5 to 7 days [3,4] subjecting patients to a prolonged hospital stay, and adding to the physical, psychological, and economic burden associated with PJI management [5-7].

In this study, Goodson et al developed a fast-track PJI care system using an infectious disease physician to coordinate the treatment of PJI patients with the TJA team. They retrospectively reviewed 78 fast-track patients who were discharged once ready for mobilization before finalization of the culture results. This was compared to control cohort of 67 patients with a standard discharge after all culture results and susceptibilities were finalized. They found that LOS was significantly lower (3.8 vs 5.7 d, p=.012) in the fast track group, with no events of antibiotic mismatch compared to the control group. No significant differences were noted comparing 90-day complications, reimplantation rate, or 12-month reimplantation survival rates between both groups. Based on these findings, they concluded that streamlining care pathway in treatment of PJI is safe and can significantly shorten hospital LOS and help to decrease the overall healthcare costs associated with treating PJI.

Acknowledged limitations of the study included small sample size which was attributed to the relative recent implementation of the program, low 12-month follow up rates (only 53%), variability of insurance approvals of home administered antibiotics and, finally, limited true secondary outcomes as some events may take place in other institutions (e.g complications and readmission).

References

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