Positive Preoperative Colonization With Methicillin Resistant Staphylococcus Aureus Is Associated With Inferior Postoperative Outcomes in Patients Undergoing Total Joint Arthroplasty |
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| Affiliation: | 1. Department of Orthopaedic Surgery, NYU Langone Health, New York, New York;2. Division of Orthopaedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel;1. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio;2. Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina;3. Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina;4. Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland;1. Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada;2. Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada;3. Imaging Group, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada;1. Department of Orthopaedic Surgery, Yale University, New Haven, Connecticut;2. Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan;3. Department of Orthopaedic Surgery, New York University, New York, New York;1. Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas;2. Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana |
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| Abstract: | BackgroundThe impact of preoperative nasal colonization with methicillin resistant staphylococcus aureus (MRSA) on total joint arthroplasty (TJA) outcomes is not well understood. This study aimed to evaluate complications following TJA based on patients’ preoperative staphylococcal colonization status.MethodsWe retrospectively analyzed all patients undergoing primary TJA between 2011 and 2022 who completed a preoperative nasal culture swab for staphylococcal colonization. Patients were 1:1:1 propensity matched using baseline characteristics, and stratified into 3 groups based on their colonization status: MRSA positive (MRSA+), methicillin sensitive staphylococcus aureus positive (MSSA+), and MSSA/MRSA negative (MSSA/MRSA−). All MRSA+ and MSSA + underwent decolonization with 5% povidone iodine, with the addition of intravenous vancomycin for MRSA + patients. Surgical outcomes were compared between groups. Of the 33,854 patients evaluated, 711 were included in final matched analysis (237 per group).ResultsThe MRSA + TJA patients had longer hospital lengths of stay (P = .008), were less likely to discharge home (P = .003), and had higher 30-day (P = .030) and 90-day (P = .033) readmission rates compared to MSSA+ and MSSA/MRSA-patients, though 90-day major and minor complications were comparable across groups. MRSA + patients had higher rates of all-cause (P = .020), aseptic (P = .025) and septic revisions (P = .049) compared to the other cohorts. These findings held true for both total knee and total hip arthroplasty patients when analyzed separately.ConclusionDespite targeted perioperative decolonization, MRSA + patients undergoing TJA have longer lengths of stay, higher readmission rates, and higher septic and aseptic revision rates. Surgeons should consider patients’ preoperative MRSA colonization status when counseling on the risks of TJA. |
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| Keywords: | total joint arthroplasty complications methicillin resistant staphylococcus aureus MRSA decolonization |
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