Does concomitant gout in septic arthritis affect surgical outcomes?

• Published in: Injury 2023-02, Vol.54 (2), p.409-415
• Main Authors: Hong, Choon Chiet, Chan, Ming Chun, Wu, Tianyi, Toh, Mingzhou, Tay, Yuan Jie, Tan, Jiong Hao
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Amputation; Amputation, Surgical; Arthritis, Infectious - complications; Arthritis, Infectious - drug therapy; Arthritis, Infectious - surgery; Gout; Gout - complications; Gout - surgery; Humans; Middle Aged; Morbidity; Mortality; Outcomes; Prospective Studies; Retrospective Studies; Septic arthritis; Treatment Outcome; Young Adult
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2022.10.028

•Concomitant septic arthritis and gout poses significant challenge in the diagnostic stage and carries high risks of complications.•A notable proportion of patients needed supportive care in the high dependency unit and/or intensive care unit during treatment and having concurrent septic arthritis and gout independently predicted a significantly longer length of stay by 12.6 days on average.•The patients are also more likely to end up with limb amputation when compared to those without coexisting gout on univariate analysis. We aim to review and describe the proportion of patients with co-existing gout amongst patients with surgical treated septic arthritis, characterize their clinical presentation, outcomes and complications compared to patients with native joint septic arthritis. Sixty-one patients with surgically treated primary joint septic arthritis were identified from the period of January 2011 to December 2016. There were 13 (21.3%) patients with co-existing septic arthritis and crystal proven gout. Pertinent details such as demographics, comorbidities, clinical features on presentation, infection markers, number of surgeries, length of stay (LOS) in general and individual LOS in supportive care units, limb amputations, readmissions and mortality were reviewed. Multiple linear and logistic regression models were used to control for confounders during analysis. The average age of patients was 60.8 years (range: 23–87 years). The patients with gout are associated with comorbidities such as being hypertensive, hyperlipidemia and renal impaired. They tend to present with ankle joint involvement (46.2% vs 8.3%; p = 0.004) while septic arthritis patients without gout tend to present with knee joint involvement (75% vs 46.2%; p = 0.046). In terms of complications, up to two thirds of them require supportive care in the High Dependency Unit and/or Intensive Care Unit during treatment (61.5% vs 29.2%; p = 0.031) and having gout with septic arthritis independently predicted a significant increase in LOS by an additional 12.6 days on average (95% CI: 2.11 – 23.03; p = 0.019). They are also more likely to end up with limb amputation (23.1% vs 0%; p = 0.008) on univariate analysis. Gout accompanying septic arthritis in the same joint is potentially associated with major systemic and joint related sequela, complications in terms of prolonged hospital stay, need for complex care and risk for limb amputation. Our findings further indicate the value and need for we