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Background <p>Septic arthritis is associated with substantial morbidity and mortality. While surgical irrigation and debridement are commonly recommended, non-surgical management remains frequently utilized, particularly in medically complex patients. However, large-scale national comparisons between these strategies are limited. This study aimed to compare in-hospital outcomes of surgical versus non-surgical management using a nationwide database.</p> Methods <p>A retrospective cohort study was conducted using the National Inpatient Sample (2016–2021). Adult hospitalizations with septic arthritis and known anatomic sites were identified using ICD-10 codes and stratified by treatment strategy. Primary outcomes included in-hospital mortality, length of stay, and total hospital charges. Secondary outcomes included in-hospital complications. Multivariable logistic regression was used to assess independent associations between treatment and outcomes, adjusting for demographics and comorbidities.</p> Results <p>A total of 46,282 hospitalizations were identified, including 27,961 (60.4%) treated surgically and 18,321 (39.6%) non-surgically. In-hospital mortality was significantly lower in the surgical group (1.4% vs. 3.1%, p &lt; 0.001). Length of stay was similar, though more variable in the non-surgical cohort. Surgical management was associated with higher hospital charges ($71,725 vs. $63,434, p &lt; 0.001). Non-surgical treatment demonstrated higher rates of complications, including sepsis, acute kidney injury, respiratory failure, and thromboembolic events (all p &lt; 0.001). After adjustment, surgical management remained independently associated with reduced complications, including respiratory failure (OR 0.552), stroke (OR 0.505), cardiac arrest (OR 0.353), and sepsis (OR 0.871) (all p &lt; 0.001).</p> Conclusions <p>Surgical management of septic arthritis was associated with lower in-hospital mortality and fewer complications despite higher costs. However, these findings should be interpreted in the context of potential residual confounding and differences in baseline illness severity between treatment groups.</p>

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Management of septic joints in the United States: A Nationwide comparison of surgical and non-surgical treatment

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月24日

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  • Assil Mahamid,
  • Mustafa Yassin,
  • Basil Habiballa,
  • Mohanad Natsheh,
  • Hamza Murad,
  • Dror Robinson,
  • Barak Haviv,
  • Ali Yassin,
  • Muhammad Khatib

摘要

Background

Septic arthritis is associated with substantial morbidity and mortality. While surgical irrigation and debridement are commonly recommended, non-surgical management remains frequently utilized, particularly in medically complex patients. However, large-scale national comparisons between these strategies are limited. This study aimed to compare in-hospital outcomes of surgical versus non-surgical management using a nationwide database.

Methods

A retrospective cohort study was conducted using the National Inpatient Sample (2016–2021). Adult hospitalizations with septic arthritis and known anatomic sites were identified using ICD-10 codes and stratified by treatment strategy. Primary outcomes included in-hospital mortality, length of stay, and total hospital charges. Secondary outcomes included in-hospital complications. Multivariable logistic regression was used to assess independent associations between treatment and outcomes, adjusting for demographics and comorbidities.

Results

A total of 46,282 hospitalizations were identified, including 27,961 (60.4%) treated surgically and 18,321 (39.6%) non-surgically. In-hospital mortality was significantly lower in the surgical group (1.4% vs. 3.1%, p < 0.001). Length of stay was similar, though more variable in the non-surgical cohort. Surgical management was associated with higher hospital charges ($71,725 vs. $63,434, p < 0.001). Non-surgical treatment demonstrated higher rates of complications, including sepsis, acute kidney injury, respiratory failure, and thromboembolic events (all p < 0.001). After adjustment, surgical management remained independently associated with reduced complications, including respiratory failure (OR 0.552), stroke (OR 0.505), cardiac arrest (OR 0.353), and sepsis (OR 0.871) (all p < 0.001).

Conclusions

Surgical management of septic arthritis was associated with lower in-hospital mortality and fewer complications despite higher costs. However, these findings should be interpreted in the context of potential residual confounding and differences in baseline illness severity between treatment groups.