Timing from admission to debridement, antibiotic, and implant retention (DAIR) affects mortality risk in total hip prosthetic joint infections

Abstract. Introduction: Recent work in total knee arthroplasty (TKA) prosthetic joint infection (PJI) suggests that timing from hospital admission to DAIR (debridement, antibiotic, and implant retention) is a modifiable risk factor influencing treatment outcomes. The study assessed the impact of timing from admission to DAIR on clinical outcomes and treatment success in the total hip arthroplasty (THA) PJI population. Methods: A retrospective review was conducted at a specialized PJI tertiary referral centre. Patients who underwent DAIR for THA PJI between 2008 and 2021 with a minimum 2-year follow-up were included. The primary outcome was reoperation for recalcitrant PJI. Secondary outcomes included 90 d readmission, 90 d and 1-year mortality, and postoperative complications. Multivariate regression analysis identified factors associated with DAIR outcomes. Results: A total of 100 patients satisfied the inclusion criteria. The mean time from admission to DAIR was 46.4 ± 45.1 h, and 52.0 % required reoperation for recalcitrant PJI. Prolonged time from admission to DAIR was associated with increased 90 d mortality (odds ratio or OR: 1.02, CI (confidence interval) 95 %: 1.00–1.03, p= 0.04). Increasing age was associated with greater 1-year mortality (OR: 1.06, CI 95 %: 1.00–1.12, p= 0.049). McPherson host grade C compared to grade A was associated with both greater 1-year mortality (OR: 12.75, CI 95 %: 1.11–146.09, p= 0.04) and postoperative complications (OR: 7.59, CI 95 %: 1.22–47.08, p= 0.03). McPherson extremity grade II versus grade I (OR: 3.28, CI 95 %: 1.21–8.92, p= 0.02) and revision THAs (OR: 0.15, CI 95 %: 0.03–0.72, p= 0.02) were associated with postoperative complications. Lower haemoglobin levels (OR: 1.04, CI 95 %: 1.01–1.07, p= 0.004) were associated with higher reoperation risk. Conclusion: In a DAIR-treated cohort, increased time from admission to surgery was associated with greater 90 d mortality in THA PJI patients. Timely surgical intervention and optimization of modifiable risk factors are essential to improve outcomes.