Total Hip Arthroplasty Patients Who Have Ostomies Have an Increased Risk of Revisions for Periprosthetic Joint Infection, but Total Knee Arthroplasty Patients Do Not.

ABSTRACT

BACKGROUND: Patient comorbidities can lead to worse outcomes and increase the risk of revisions after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Sparse research is available on the effects of ostomies on postoperative outcomes. Our study aimed to assess whether patients who have ostomies, who underwent TKA or THA, have worse outcomes and increased rates of all-cause and periprosthetic joint infection (PJI)-related revisions. METHODS: We performed a retrospective cohort study comparing the outcomes of THA and TKA patients who have and do not have a history of ostomy using the Statewide Planning and Research Cooperative System. Patient demographics, ostomy diagnosis, 3-month emergency department visits and readmissions, and revisions were collected. A total of 126,414 THA and 216,037 TKA cases were included. Log-rank testing and a Cox proportional hazards model were used to account for covariates. RESULTS: In total, 463 THA patients (0.4%) had ostomies. They had a longer length of stay (4.0 versus 3.1 days, P < 0.001) and were less likely to be discharged home (55.3 versus 62.2%, P = 0.01). They had higher rates of PJI-related revisions (1.9 versus 0.9%, P = 0.02) and had increased odds of PJI-related revision (OR [odds ratio] = 2.2, P = 0.02). Of TKA patients, 619 patients (0.3%) had an ostomy. They had a longer length of stay (3.6 versus 3.3 days, P = 0.02) and was less likely to be discharged home (49.4 versus 52.4%, P = 0.16). However, there was no difference in the rate (1.8 versus 1.4%, P = 0.49) or odds (OR = 1.2, P = 0.53) of PJI-related revision. CONCLUSIONS: THA, but not TKA, patients who have ostomies have an increased risk of PJI-related revisions. The proximity of the surgical incision to the ostomy site may play a role in the risk of PJI in THA patients.