Long-term follow-up of surgical complications and general health after preoperative optimisation for primary arthroplasty: a prospective quasi-experimental study.

内容摘要

Preoperative optimisation programmes aim to reduce complications after total joint arthroplasty (TJA), yet long-term effects on superficial surgical site infections (SSI), periprosthetic joint infections (PJI) and overall health remain unclear. This study evaluated the long-term impact of preoperative optimisation in cooperation with hospital and primary healthcare on infection outcomes and general health following elective primary lower extremity TJA. In this prospective quasi-experimental study, 1484 patients undergoing TJA were followed postoperatively. The intervention group underwent a multifactorial optimisation process 6-12 months preoperatively, while the control group received conventional preparation. Landspitali University Hospital and Primary Health Care in Iceland treating patients undergoing primary TJA between August 2018 and December 2022. The intervention group comprised 746 patients and the control group 738. Of the intervention group, 77% received surgery during the COVID-19 pandemic versus 5% in the control group. Outcomes included incidence of superficial SSI at 1 year and PJI and postoperative health and mortality at 3 years. Superficial SSI occurred in 5.9% of the intervention group versus 7.9% in the control group (HR 0.67; 95% CI 0.45 to 1.01), with 95% versus 98% appearing within 6 weeks. PJI occurred in 2.0% versus 1.1%, respectively (HR 1.80; 95% CI 0.76 to 4.30). Most PJIs (80 vs 88%) followed superficial SSI, the majority within a week. Progression from superficial SSI to PJI was higher in the intervention group (27.3% vs 12.1%). No significant differences were found in postoperative health or mortality. At 1 year postoperatively, no significant long-term reductions in superficial SSI were found, nor at 3 years in PJI or general health. Confounding factors, including COVID-19-related disruptions and organisational changes, may have influenced outcomes. The study emphasises the importance of prospective evaluation of preoperative optimisation strategies as well as organisational and practice changes on patient outcome. NCT05399186.