Sociobiome in Periprosthetic Joint Infection: The Effect of Social Determinants of Health on Microorganism Profile and Clinical Outcomes
Abstract
BACKGROUND: Social determinants of health (SDOH) have been shown to reliably predict outcomes in patients undergoing total joint arthroplasty (TJA). However, there remains a paucity of data in the literature on SDOH in patients being revised for periprosthetic joint infection (PJI). This study aimed to examine the relationship between SDOH, microorganism profile, and clinical outcomes in patients undergoing their first revision procedure for infection. METHODS: Four hundred eighty-five patients undergoing revision arthroplasty for infection were identified using an institutional PJI database. PJI was defined using the 2018 International Consensus Meeting criteria. Data on microorganism profile, antibiotic sensitivity, demographics, and comorbidities were recorded. The area deprivation index (ADI) and four subscales of the social vulnerability index (SVI) were identified using the patient address. High vulnerability to SDOH was defined as the top quartile for ADI and each SVI category. RESULTS: Two hundred five patients were included. Patients in the high-vulnerability cohort for ADI and SVI were more likely to be Black and had higher rates of type 2 diabetes ( P < 0.001). In a multivariate regression, ADI was found to be an independent risk factor for gram-negative (odds ratio [OR] = 3.23, P = 0.031) and polymicrobial (OR = 3.62, P = 0.044) infections. Having a higher ADI and SVI was a risk factor for increased length of stay (LOS; ß 1.07, P = 0.038; ß 1.24, P = 0.001) and non-home discharge (OR = 3.08, P = 0.027; OR = 2.62, P = 0.013), respectively. The top SVI theme 1 was an independent risk factor for prolonged LOS (ß 1.85, confidence interval, 1.06 to 2.64, P < 0.001). CONCLUSION: Patients with an increased ADI and SVI were more likely to experience gram-negative and polymicrobial infections, as well as prolonged LOS and non-home discharge. The findings of this study suggest that the "sociobiome" has an effect on the incidence and postoperative outcomes of PJI. The findings of this study demonstrate that SDOH indices can be a useful tool in categorizing high-risk patients and mitigating health inequalities in septic revision procedures.
