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The impact of systemic lupus erythematosus on the risk of infection after total hip arthroplasty: a nationwide population-based matched cohort study

Authors
  • Chen, Chien-Hao1
  • Chen, Tien-Hsing2, 3
  • Lin, Yu-Sheng4
  • Chen, Dave W.1
  • Sun, Chi-Chin1, 5, 1
  • Kuo, Liang-Tseng6, 5
  • Shao, Shih-Chieh3, 7, 8
  • 1 Chang Gung Memorial Hospital, Keelung, Taiwan , Keelung (Taiwan)
  • 2 Chang Gung University College of Medicine, Keelung, Taiwan , Keelung (Taiwan)
  • 3 Biostatistical Consultation Center of Chang Gung Memorial Hospital, Keelung, Taiwan , Keelung (Taiwan)
  • 4 Chang Gung Memorial Hospital, Chiayi, Taiwan , Chiayi (Taiwan)
  • 5 Chang Gung University, Taoyuan, Taiwan , Taoyuan (Taiwan)
  • 6 Chang Gung Memorial Hospital, Chiayi, Taiwan. No. 6 West Sec, Chia-Pu Road, Putz City, Chiayi, Taiwan , Chiayi (Taiwan)
  • 7 Keelung Chang Gung Memorial Hospital, Keelung, Taiwan , Keelung (Taiwan)
  • 8 National Cheng Kung University, Tainan, Taiwan , Tainan (Taiwan)
Type
Published Article
Journal
Arthritis Research & Therapy
Publisher
Springer Science and Business Media LLC
Publication Date
Sep 14, 2020
Volume
22
Issue
1
Identifiers
DOI: 10.1186/s13075-020-02300-1
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundWe aimed to assess the impact of systemic lupus erythematosus (SLE) on the risk of infection after total hip arthroplasty (THA).MethodsWe identified patients undergoing primary THA (1996–2013) in Taiwan National Health Insurance Research Database (NHIRD). Patients were then divided into the SLE and control groups according to the diagnosis of SLE. We used 1:1 propensity score to match the control to the SLE group by age, sex, and comorbidities. The primary outcome was infection, including early and late superficial wound infection and periprosthetic joint infection (PJI). The secondary outcome was in-hospital complications.ResultsWe enrolled 325 patients in each group. In the primary outcome, the incidence of early superficial wound infection and PJI was comparable between the SLE and matched-control group. However, the incidence of late superficial wound infection and PJI in the SLE group was higher than that in matched-control group (11.4% vs. 5.5%, P = 0.01; 5.2% vs 2.2%, P = 0.04, respectively). Furthermore, the SLE group had a higher risk for late superficial wound infection and PJI (hazard ratio = 2.37, 95% confidence interval (CI) 1.35–4.16; HR = 2.74, 95% CI 1.14–6.64, respectively) than the matched-control. Complications other than infection and in-hospital mortality cannot be compared because of very low incidence.ConclusionsSLE is a risk factor for developing late superficial wound infection and PJI, but not for early postoperative complications following THA. Clinical presentations should be monitored to avoid misdiagnosis of PJI in SLE patients after THA.

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