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ORLANDO -- Patients who develop urinary tract or surgical site infections or pneumonia after undergoing joint replacement surgery are at risk for sepsis and associated mortality, a researchers said here.

Among 117,935 patients who had total hip or knee arthroplasty, a total of 402 (0.34%) developed sepsis, according to , an orthopedic surgeon in Chicago.

And among those who developed sepsis, the mortality rate was 3.7% compared with 0.1% among those who were nonseptic, a 28-fold increase (P<0.001), he said at the

"Sepsis is a rare but very serious complication of total joint arthroplasty that has been reported at rates of 0.15% to 0.9%, with a 32-fold increase in mortality," Bohl said.

Infections of the urinary tract and surgical site, as well as pneumonia, have been recognized as potential sources of sepsis, but risk factors for these events have not been fully characterized.

So the researchers identified patients in the American College of Surgeons National Surgical Quality Improvement Program database who had hip or knee replacement during the years 2005 to 2013.

They found that among the patients who developed sepsis, 31% had a concomitant urinary tract infection, 27% had a surgical site infection, and 15% had pneumonia. In addition, 5% had multiple sites of infection and the remainder had no identifiable source.

Rates of sepsis were increased among patients who had urinary tract infections (9.2% versus 0.2%, P<0.001), surgical site infections (14.7% versus 0.3%, P<0.001), and pneumonia (9.5% versus 0.3%, P<0.001).

A number of independent risk factors were identified as being associated with the development of sepsis, including age of 80 or greater (RR 1.7, 95% CI 1.2-2.4, P<0.001), male sex (RR 1.3, 95% CI 1.1-1.6, P=0.003), and operative time of 100 minutes or more (RR 2.1, 95% CI 1.6-2.7, P<0.001).

In addition, being functionally dependent (RR 2.1, 95% CI 1.4-3.1, P<0.001), having insulin-dependent diabetes (RR 2.7, 95% CI 1.9-3.7, P<0.001), being hypertensive (RR 1.9, 95% CI 1.5-2.4, P<0.001), having chronic obstructive pulmonary disease (RR 2, 95% CI 1.4-2.9, P<0.001), and being a current smoker (RR 1.4, 95% CI 1-1.9, P=0.036) also were associated with sepsis.

"This study suggests that the rate of sepsis after total joint arthroplasty is about 1 in 300, and given the seriousness of this complication, patients with urinary tract or surgical site infections or pneumonia should be treated aggressively to limit the risk of mortality," Bohl concluded.