256. PICC Complications Are Common Reasons for ED Visits After PJI
Authors: Charalambous Lefko T , Kim Billy , Case Ayden , Duensing Ian , Brown Meredith , Jiranek William , Seidelman Jessica , Bolognesi Michael , Seyler Thorsten 
Published: December 2021

Abstract

Background
Peri-prosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty (TJA) requiring surgical intervention and prolonged parenteral antibiotics. Often plagued by complications, the purpose of this study was to characterize the postoperative PICC (peripherally-inserted central catheter) line related complications and readmissions.

Causes for 90-Day ED Visits after Revision Surgery for PJI. The figure quantifies causes for ED visits after PJI revision surgery with subsequent PICC line placement. Readmissions from ED are highlighted in blue.

PICC-specific problems at ED visit. The figure quantifies the specific PICC-line problems that brought patients to the ED. Readmissions from ED are highlighted in blue.

Methods
We retrospectively queried an institutional database for total hip (THA) and total knee (TKA) arthroplasty patients from January 2015 through December 2020 that developed a PJI and required PICC placement. Patient demographics, comorbidities, readmissions, and emergency department (ED) visits were collected.

Results
889 patients (48.3% female) with a mean age of 64.6 years (18.7-95.2) underwent 435 THA and 454 TKA that were revised for PJI. The cohort had 275 (30.9%) 90-day ED visits and 284 readmissions (31.9%). Of ED visits, 51 (18.5%) were PICC-related, with only five (9.8%) leading to readmission for a PICC complication. Average time from discharge to PICC ED visit was 26.2 days (0.3-89.4). The most common reasons for 90-day ED visit after revision and PICC line placement were issues related to the joint replacement or wound site (“MSK”, n=116, 42.2%) and PICC complaints (n=51, 18.5%). A multivariable logistic regression demonstrated that non-Caucasian race (OR 2.24, 95% CI 1.24-4.04, p=0.007) and younger age (OR 0.98, 95% CI 0.95-1.00, p=0.035) were associated with PICC-related ED visits. Malpositioning (41.2%) and occlusion (35.3%) were the most common PICC complications leading to ED presentation.

Conclusion
PICC complications are common after PJI treatment accounting for nearly 20% of 90-day ED visits. Of these, malpositioning and occlusion of the PICC line occupy the vast majority of these complaints. This high level of utilization early in the course of outpatient parenteral antibiotic therapy represents areas of optimization and potential cost containment in the postoperative care of PJI patients.

Disclosures
William Jiranek, MD, Depuy Synthes (Other Financial or Material Support, Royalty/Licensing) Michael Bolognesi, MD, Heron Therapeutics, Inc. (Consultant)Total Joint Orthopedics, Inc. (Other Financial or Material Support, Royalty/Licensing)Zimmer Biomet Holdings, Inc. (Other Financial or Material Support, Royalty/Licensing) Thorsten Seyler, MD/PhD, Depuy Synthes (Other Financial or Material Support, Resident Educational Support)Extrel Therapeutics (Board Member, Shareholder)Heraeus Medical (Consultant)MiCare Path (Board Member, Shareholder)OREF (Grant/Research Support)Pattern health (Board Member)Restor3D (Other Financial or Material Support, Royalties)Smith+Nephew, Inc. (Grant/Research Support, Speaker’s Bureau)Stryker (Other Financial or Material Support, Resident Educational Support)Total Joint Orthopedics, Inc. (Consultant)Wolters Kluwer Health (Other Financial or Material Support, Royalties)Zimmer Biomet (Grant/Research Support)