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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted using the National Inpatient Sample (2016\u20132021). 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats: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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00264-026-06909-w","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:54:24Z","timestamp":1782280464000},"page":"1523-1534","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Management of septic joints in the United States: A Nationwide comparison of surgical and non-surgical treatment"],"prefix":"10.1007","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3676-7099","authenticated-orcid":false,"given":"Assil","family":"Mahamid","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Yassin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basil","family":"Habiballa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohanad","family":"Natsheh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamza","family":"Murad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dror","family":"Robinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barak","family":"Haviv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Yassin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Khatib","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"issue":"9097","key":"6909_CR1","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/S0140-6736(97)09522-6","volume":"351","author":"DL Goldenberg","year":"1998","unstructured":"Goldenberg DL (1998) Septic arthritis. 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