2024 General Surgery/Global Health Engagement/Quality Improvement Presentations

MSS04: TO SCOPE OR NOT TO SCOPE? INCIDENCE OF AND RISK FACTORS FOR PERIPROSTHETIC JOINT INFECTION IN PATIENTS WITH TOTAL HIP AND KNEE ARTHROPLASTY UNDERGOING COLONOSCOPY
Ashley B Anderson, MD; Sean Slaven, MD; N Watson, MD; John Cody, MD; R McGill, MD; B. Kyle Potter, MD, FACS; Matthew Nealeigh, DO, MHPE, FACS; Uniformed Services University / Walter Reed National Military Medical Center

Introduction:

Periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) is a rare but devastating complication. Most TJA patients also need screening colonoscopy, where transient bacteremia may be a potential source for hematogenous PJI. Patients and surgeons must decide on an optimal time span or sequence for these two generally elective procedures, but no such guidelines currently exist.

Methods:

We retrospectively analyzed patients >45 years old in the Military Health System undergoing colonoscopy in the year prior to total hip and/or knee arthroplasty. Multivariable logistic regression examined risk factors for PJI. Patients undergoing colonoscopy in the year post-TJA were similarly analyzed, using propensity-matched, nearest-neighbor matching.

Results: 

Of 243,671 TJA patients, 11,482 underwent colonoscopy before, and 7,500 after, total hip and/or knee replacement. PJI within one year postoperatively was not associated with colonoscopy (2.8% in colonoscopy patients versus 2.4% in non-colonoscopy patients within one year prior to surgery (OR = 1.07; 95% CI = 0.98, 1.17)). Colonoscopy after TJA was also not associated with PJI incidence within one year post TJA (1.8% in the colonoscopy vs 1.9% in the no-colonoscopy control cohort (OR = 0.98; 95% CI = 0.81, 1.17)). In both pre-operative and post-operative colonoscopy analyses, several chronic health conditions were associated with higher PJI risk.

Discussion and Conclusion:

Perioperative screening colonoscopy was not associated with PJI in this population. However, several chronic health conditions were independently associated with infections, and should be medically optimized prior to and post TJA. Screening colonoscopy should not be delayed in an attempt to mitigate perioperative risk for total joint arthroplasty.