Arthroscopy Versus Open Arthrotomy for Septic Arthritis of the Wrist: A Nationwide Inpatient Sample Analysis of 1,065 Cases.

Purpose: Septic arthritis of the wrist is an uncommon condition, but one that can result in substantial morbidity. Limited data exist on the inpatient outcomes of septic arthritis of the wrist among patients treated using arthroscopy versus open arthrotomy. The purpose of our study was to compare the reoperation rates and inpatient complications between these two procedures. Methods: The Nationwide Inpatient Sample database was used to identify patients 18 years old and older with a diagnosis of septic arthritis of the wrist in the United States from 2002 to 2012. Septic arthritis cases were classified based on the treatment modality, and patients who were treated either arthroscopically or using arthrotomy were included in statistical analysis. Hospitalization outcomes, including reoperation rates and surgical and medical complications were compared after adjusting for age, sex, race, and comorbidities in multivariate logistic regression analysis. Mean costs and length of stay were compared using the Student's t- test. Results: A total of 1,065 patients with septic arthritis of the wrist were treated either arthroscopically (n = 516) or by open arthrotomy (n = 549). Patients who were treated arthroscopically had higher reoperation rates (48.6% vs 8.7%). Using multivariate analysis, patients who were treated arthroscopically were more likely to undergo repeat arthroscopic procedures (odds radio [OR], 10.4; 95% CI,7.0-15.3), although they were not different in terms of the risk of development of medical (OR, 1.20; 95% CI, 0.80-1.80) or surgical (OR, 0.87; 95% CI, 0.65-1.16) complications. Arthroscopy and arthrotomy also did not differ in terms of length of stay (6.29 ± 5.0 vs 6.26 ± 4.5) and inpatient hospital charges (33,563.4 ± 30,296.3 vs 34,422.6 ± 31,362.0). Conclusions: Orthopedic surgeons should be aware of the increased rate of reoperation when managing patients with septic arthritis of the wrist arthroscopically and should discuss this potential risk with surgical candidates. Type of study/level of evidence: Prognostic III.