Meningitis or epidural abscesses after neuraxial block for removal of infected hip or knee prostheses

Karina Gritsenko, D. Marcello, G. A. Liguori, K. Jules-Elysée, S. G. Memtsoudis

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background. Infection, whether localized or systemic, can be a relative contraindication to neuraxial anaesthesia. Data correlating neuraxial anaesthesia and the development of meningitis or epidural abscess in this setting are limited. Methods. Retrospective chart review was performed on 710 medical records of patients admitted between 1998 and 2009 for removal of potentially infected total hip and total knee prostheses. Ultimately, 474 patients were identified as being infected. Factors that predisposed a patient to an immunocompromised state, and signs and symptoms of infection in the pre-, intra-, and postoperative stages were documented. Bacteraemic patients were reviewed for signs of neuraxial infection. The endpoint of follow-up was development of complications before hospital discharge. Results. All 474 patients had removal of the infected prosthesis under neuraxial anaesthesia. Mean patient age was 65.5 yr (58 >65 yr) and mean length of hospital stay was 21 days. Patient characteristics included concurrent disease (65), steroid use (5.3), preoperative antibiotic use (50.8), signs of inflammatory process (84), bacteraemia (4.2), and documented positive intraoperative joint cultures (88). Using clinical standards for diagnosis of central neuraxial infection, patients developed infectious complications (incidence of 0.6 on 95 confidence interval), although three patients had findings attributable to anaesthesia, including epidural haematoma, psoas abscess, and back pain. Conclusions. Based on clinical criteria, our findings suggest that the incidence of central nervous system infection after neuraxial anaesthesia in patients with infected hip and knee prostheses is low after neuraxial block.

Original languageEnglish (US)
Pages (from-to)485-490
Number of pages6
JournalBritish Journal of Anaesthesia
Volume108
Issue number3
DOIs
StatePublished - Mar 2012
Externally publishedYes

Fingerprint

Epidural Abscess
Knee Prosthesis
Hip Prosthesis
Meningitis
Anesthesia
Infection
Length of Stay
Psoas Abscess
Central Nervous System Infections
Epidural Anesthesia
Incidence
Immunocompromised Host
Back Pain
Bacteremia
Hematoma
Signs and Symptoms
Prostheses and Implants
Medical Records
Hip
Joints

Keywords

  • epidural abscess
  • meningitis bacterial
  • neuraxial anaesthesia complications
  • postoperative complications
  • prosthesis-related infections

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Meningitis or epidural abscesses after neuraxial block for removal of infected hip or knee prostheses. / Gritsenko, Karina; Marcello, D.; Liguori, G. A.; Jules-Elysée, K.; Memtsoudis, S. G.

In: British Journal of Anaesthesia, Vol. 108, No. 3, 03.2012, p. 485-490.

Research output: Contribution to journalArticle

Gritsenko, Karina ; Marcello, D. ; Liguori, G. A. ; Jules-Elysée, K. ; Memtsoudis, S. G. / Meningitis or epidural abscesses after neuraxial block for removal of infected hip or knee prostheses. In: British Journal of Anaesthesia. 2012 ; Vol. 108, No. 3. pp. 485-490.
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