Joint problems, infections top reasons for Sonoma County hospital visits

Lee Olibas is happy to have a 6-inch titanium shaft in his left thigh bone.

“No pain,” the 69-year-old Santa Rosa man said Thursday, a day after hip replacement surgery at Santa Rosa Memorial Hospital rid him of an arthritis-ravaged joint.

Olibas said he’d been “in terrible pain” nonstop for the past month, since X-rays revealed the ball of his femur, or thigh bone, and the socket in his hip had lost their naturally cushioning cartilage and were rubbing “bone against bone.”

He’s an example of the No. 1 reason why people are admitted to Sonoma County hospitals for treatment of ailments ranging from life-threatening heart attacks and infections to seizures, strokes, broken bones, asthma and headaches.

A total of 38,232 patients were admitted to the county’s seven acute-care hospitals last year, a number nearly equal to the population of Rohnert Park. Major joint replacement - including hips, knees and some shoulders - was the reason for 1,953 hospitalizations, the largest single group of ailments, according to a report by the Office of Statewide Health Planning and Development.

Septicemia, a serious bloodstream infection, was a close second on the list of ailments, accounting for 1,934 hospitalizations, far ahead of the third- and fourth-leading causes - esophagitis and other digestive disorders (712 hospitalizations) and pneumonia (709).

Sonoma County’s hospitals were a source of joy for the largest group of patients: about 5,000 women who gave birth.

The figures are for hospital patients receiving acute care and do not include emergency room visits or care for chemical dependency recovery, physical rehabilitation, psychiatric conditions or skilled nursing services.

The 20 leading reasons for hospitalization - with the exception of appendectomy and cellulitis (tissue infection) - are largely consequences of aging, local physicians said, in a county with a so-called “gray tsunami” of about 81,000 residents age 60 and over, making up more than 16 percent of the total population.

The same group of older adults accounted for more than 35 percent of total acute-care hospitalizations, said Dr. Karen Holbrook, the county’s interim health officer.

By 2020, 1 in 5 county residents will be 65 and older, according to state projections.

Joint replacement and septicemia are both due to aging and part of nationwide trends.

“We have an aging and active population,” said Dr. Richard Carvolth, Memorial Hospital’s chief medical officer. “People’s joints are wearing out. They don’t want their lifestyle curtailed.”

Joint replacement hardware and surgical techniques are improving, reducing the operations’ risks and enhancing the outcomes, he said.

Hip replacement surgery started in 1960, followed by knee replacements in 1968, and both are considered among “the most successful procedures in all of medicine,” according to the American Academy of Orthopedic Surgeons.

More than 600,000 knee replacements and 285,000 hip replacements are done each year nationwide, the academy said.

As baby boomers age, “we know there will continue to be a steady flow of joint replacement surgery,” Carvolth said.

Patients typically are hospitalized for one or two days following joint replacement surgery. In Sonoma County, joint replacements accounted for 4.8 percent of all hospitalizations last year.

Septicemia is a generic term for severe infection caused by bacteria in the blood. It can be challenging to pinpoint the source of infection, which can arise from almost any point in the body, including the lungs, bladder, bowel, skin or soft tissue.

Patients must be hospitalized because they need intravenous antibiotics, testing and close monitoring, Carvolth said. If not quickly controlled, septicemia can lead to life-threatening septic shock, he said.

The number and rate of hospitalizations for septicemia more than doubled nationwide from 2000 through 2008, and the cost of treatment, often in hospital intensive care units, was estimated at $14.6 billion in 2008, according to the U.S. Centers for Disease Control and Prevention.

About two-thirds of patients hospitalized for septicemia in 2008 were age 65 and older, and the rate for patients 85 and over was about 30 times the rate of those under 65, the agency said.

Three heart conditions were among Sonoma County’s 20 most common reasons for hospital care.

Heart failure, with 609 hospitalizations last year, is a progressive weakening of the heart muscle, usually a lingering condition and prevalent among the elderly, Carvolth said.

Myocardial infarction, commonly known as a heart attack, sent 431 people to local hospitals in 2013. It is triggered by blockage, closure or rupture of coronary arteries, reducing blood flow to the heart and the death of heart muscles, he said.

Despite major advances in cardiac care and disease prevention, heart attacks remain “a potentially fatal event,” Carvolth said.

Every year, about 715,000 Americans have a heart attack and about 15 percent of them will die from it, according to the CDC.

Cardiac arrhythmia, which accounted for 420 hospitalizations last year, is an irregular or erratic heartbeat that requires immediate treatment.

Dr. Stephen Steady, a Petaluma gastroenterologist, said he wasn’t surprised that four intestinal tract ailments were among the 20 major reasons for hospitalization.

The intestinal tract, which runs from the mouth to the anus, is a “very complex system” of muscles and nerves that is sometimes called “the second brain,” he said.

Esophagitis, an inflammation of the lining of the tube that carries food from the mouth to the stomach, typically occurs among older people who are overweight, sedentary and eat too much, Steady said. The weakening of a sphincter muscle allows stomach acid to “bubble up” into the esophagus, causing ulcerations.

Gastrointestinal hemorrhage, or bleeding, is an age-related affliction caused by ulcers from infection or overuse of aspirin and other non-steroidal medication such as ibuprofen, Steady said.

Dr. Joshua Weil, assistant physician in chief for hospital operations at Kaiser Permanente’s Santa Rosa Medical Center, said the reasons for hospitalization will change over time as physicians find ways to treat more conditions on an outpatient basis.

For example, blood clots in the legs - which can travel to the lungs and cause damage or death - used to require hospitalization but can now be treated with medication in some cases, Weil said.

Hospitalization is essential for patients who need intensive care or close monitoring, but hospitals also pose hazards, including bacterial infection, medication errors and sleep disruption, Weil said. Elderly patients affected by sleep loss and the unfamiliar environment of a hospital may develop life-threatening delirium, he said.

“I think some people could argue that hospitals are dangerous places,” Weil said.

Some European hospitals offer an emergency room, operating room and intensive care unit, with no medical-surgical ward, he said.

Kaiser’s goal is to “get people out of the hospital when it’s safe” and their care can be managed better at home, Weil said.

Lee Olibas, the man with one bionic joint, considers himself a beneficiary of modern medicine and will likely return to the hospital for more. His right hip is arthritic, he said.

“When it hurts, you get it done,” Olibas said.

You can reach Staff Writer Guy Kovner at 521-5457 or guy.kovner@pressdemocrat.com.