BACKGROUND This study assessed incidence, risk factors, and outcomes of Staphylococcus aureus infections (SAI) following endoprosthetic hip or knee, or spine surgeries. METHODS Adult patients with at least one of the selected surgeries from 2012 to 2015 captured in a German sickness fund database were included. SAI were identified using S. aureus-specific ICD-10 codes. Patients with certain prior surgeries and infections were excluded. Cumulative incidence and incidence density of post-surgical SAI were assessed. Risk factors, mortality, healthcare resource utilization and direct costs were compared between SAI and non-SAI groups using multivariable analyses over the 1 year follow-up. RESULTS Overall, 74,327 patients who underwent a knee (28.6%), hip (39.6%), or spine surgery (31.8%) were included. The majority were female (61.58%), with a mean age of 69.59 years and a mean Charlson Comorbidity Index (CCI) of 2.3. Overall, 1.92% of observed patients (20.20 SAI per 1000 person-years (PY)) experienced a SAI within 1 year of index hospitalization. Knee surgeries were associated with lower SAI risk compared with hip surgeries (Hazard Ratio (HR) = 0.8; p = 0.024), whereas spine surgeries did not differ significantly from hip surgeries. Compared with non-SAI group, the SAI group had on average 4.4 times the number of hospitalizations (3.1 vs. 0.7) and 7.7 times the number of hospital days (53.5 vs. 6.9) excluding the index hospitalization (p < 0.001). One year post-orthopedic mortality was 22.38% in the SAI and 5.31% in the non-SAI group (p < 0.001). The total medical costs were significantly higher in the SAI group compared to non-SAI group (42,834€ vs. 13,781€; p < 0.001). Adjusting for confounders, the SAI group had nearly 2 times the all-cause direct healthcare costs (exp(b) = 1.9; p < 0.001); and 1.72 times higher risk of death (HR = 1.72; p < 0.001). CONCLUSIONS SAI risk after orthopedic surgeries persists and is associated with significant economic burden and risk of mortality. Hence, risk reduction and prevention methods are of utmost importance.

中文翻译：

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德国整形外科手术后金黄色葡萄球菌感染的负担。

背景技术这项研究评估了假体髋或膝关节或脊柱手术后金黄色葡萄球菌感染（SAI）的发生率，危险因素和结果。方法纳入2012年至2015年在德国疾病基金数据库中捕获的具有至少一项选定手术的成年患者。使用金黄色葡萄球菌特定的ICD-10代码识别SAI。排除了具有某些先前手术和感染的患者。评估手术后SAI的累积发生率和发生密度。在1年的随访中，通过多变量分析比较了SAI组和非SAI组的风险因素，死亡率，医疗资源利用和直接成本。结果总体上，包括74327例接受过膝关节手术（28.6％），髋关节（39.6％）或脊柱外科手术（31.8％）的患者。多数为女性（61.58％），平均年龄为69.59岁，平均查尔森合并症指数（CCI）为2.3。总体而言，1.92％的观察患者（每1000人年（PY）为20.20 SAI）在指数住院的1年内经历了SAI。与髋关节手术相比，膝关节手术的SAI风险较低（危险比（HR）= 0.8； p = 0.024），而脊柱外科手术与髋关节手术没有显着差异。与非SAI组相比，SAI组的住院次数平均为4.4倍（3.1比0.7）和7.7天（53.5比6.9），不包括指数住院（p <0.001）。SAI组一年的骨科病死率是非SAI组的22.38％，非SAI组为5.31％（p <0.001）。与非SAI组相比，SAI组的总医疗费用显着更高（42,834欧元vs.13,781欧元; p <0。001）。调整混杂因素后，SAI组的直接医疗保健费用几乎是所有原因的2倍（exp（b）= 1.9； p <0.001）；死亡风险高出1.72倍（HR = 1.72； p <0.001）。结论整形外科手术后的SAI风险仍然存在，并与巨大的经济负担和死亡风险相关。因此，降低风险和预防方法至关重要。