https://orcid.org/0000-0002-9973-456X
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Abstract
Purpose
To develop a parsimonious risk prediction model for periprosthetic joint infection (PJI) within 90 days after total hip arthroplasty (THA).
Patients and Methods
We used logistic LASSO regression with bootstrap ranking to develop a risk prediction model for PJI within 90 days based on a Swedish cohort of 88,830 patients with elective THA 2008–2015. The model was externally validated on a Danish cohort with 18,854 patients.
Results
Incidence of PJI was 2.45% in Sweden and 2.17% in Denmark. A model with the underlying diagnosis for THA, body mass index (BMI), American Society for Anesthesiologists (ASA) class, sex, age, and the presence of five defined comorbidities had an area under the curve (AUC) of 0.68 (95% CI: 0.66 to 0.69) in Sweden and 0.66 (95% CI: 0.64 to 0.69) in Denmark. This was superior to traditional models based on ASA class, Charlson, Elixhauser, or the Rx Risk V comorbidity indices. Internal calibration was good for predicted probabilities up to 10%.
Conclusion
A new PJI prediction model based on easily accessible data available before THA was developed and externally validated. The model had superior discriminatory ability compared to ASA class alone or more complex comorbidity indices and had good calibration. We provide a web-based calculator (https://erikbulow.shinyapps.io/thamortpred/) to facilitate shared decision making by patients and surgeons.
Graphical abstract
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Abbreviations
ASA, American Society for Anesthesiologists; AUC, area under the curve; BMI, body mass index; CI, confidence interval; DHR, The Danish Hip Arthroplasty Register; DK, Denmark; FNI, fraction of new information; ICD, International Classification of Diseases; LASSO, least absolute shrinkage and selection operator; NOMESCO, Nordic Medico-Procedural Committee; NPR, The National Patient Register; PJI, periprosthetic joint infection; ROC, receiver operating characteristic; SD, standard deviation; SE, Sweden; SHAR, The Swedish Hip Arthroplasty Register; THA, total hip arthroplasty.
Data Sharing Statement
Access to the model derivation cohort is granted after permission from the Västra Götaland Region, as the central personal data controller agency for the SHAR, in accordance with the European General Data Protection Regulation (GDPR), as well as Swedish laws and regulations (https://registercentrum.se/vara-tjaenster/datauttag/p/B1eeV66QE).
Acknowledgments
We would like to thank Aurelie Mailhac, statistician at the Department of Clinical Epidemiology at Aarhus University, for help with the external validation.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
OR is a principal investigator for research partly founded by Pfizer; OR is a register director of the Swedish Arthroplasty Register (SAR) and board member of the International Society of Arthroplasty Registries. NPH has received institutional support from Waldemar Link GmbH, and Zimmer Biomet; also reports personal fees from Heraeus Medical, Germany. NPH is president of the Nordic Arthroplasty Register Association, member of the steering committee of SAR, and Co-Editor of Acta Orthopaedica; no other relationships or activities that could appear to have influenced the submitted work. The authors report no other conflicts of interest in this work.