Dataset Information

Direct Costs Vary by Outcome in Two-Stage Revision Arthroplasty for the Treatment of Hip Periprosthetic Joint Infection.

ABSTRACT:

Background

Two-stage revision arthroplasty is the gold standard for treating chronic prosthetic joint infection (PJI), but there has been limited analysis of the costs incurred beyond the index procedure and how additional complications and/or surgeries impact the cost of care.

Methods

The electronic health record was queried for patients who underwent a total hip arthroplasty complicated by PJI and then underwent removal of the prosthesis with implantation of an antibiotic-impregnated articulating cement spacer. Patient demographics, surgical variables, hospital readmissions, emergency department (ED) visits, and postoperative complications were recorded. Data on total costs were collected with an internal accounting database. The average follow-up duration was 3.35 years.

Results

Univariate analyses showed statistically significant differences between outcome groups (reimplantation, reimplantation requiring later revision, retained spacer, and Girdlestone resection arthroplasty) in total overall costs, ED visit costs, and postoperative costs at 1 and 2 years after the initial spacer placement. The median total cost at 2 years for each group was $38,865 ($29,144-49,471) (reimplantation), $79,223 ($53,442-100,152) (reimplantation with revision), $54,096 ($20,872-73,903) (retained spacer), $62,134 ($52,135-101,546) (Girdlestone). Patients who underwent successful reimplantation requiring no further surgery had significantly lower total costs than patients who needed revision surgeries after reimplantation ($38,865 [$29,144-49,471] vs $79,223 [$53,442-100,152], P = .007). Patients with a Girdlestone resection arthroplasty had higher total costs at 1 year ($59,708 [$41,781-80,916] vs $33,093 [$27,237-40,429], P = .043) and higher costs attributable to ED visits at 2 years than the reimplantation group ($23,581 [$14,029-41,519] vs $15,307 [$6291-29,119], P = .009).

Conclusions

A significant variation exists among total costs for the 2-stage treatment of hip PJI when stratified by the final outcome.

SUBMITTER: Wixted CM

PROVIDER: S-EPMC9713268 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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Publications

Direct Costs Vary by Outcome in Two-Stage Revision Arthroplasty for the Treatment of Hip Periprosthetic Joint Infection.

Wixted Colleen M CM Charalambous Lefko T LT Kim Billy I BI Cochrane Niall H NH Belay Elshaday S ES Joseph Hayden L HL Seyler Thorsten M TM

Arthroplasty today 20221128

<h4>Background</h4>Two-stage revision arthroplasty is the gold standard for treating chronic prosthetic joint infection (PJI), but there has been limited analysis of the costs incurred beyond the index procedure and how additional complications and/or surgeries impact the cost of care.<h4>Methods</h4>The electronic health record was queried for patients who underwent a total hip arthroplasty complicated by PJI and then underwent removal of the prosthesis with implantation of an antibiotic-impreg ...[more]

PMID: 36465692

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Project description:BackgroundDebates persist on the optimal surgical approach for treating Periprosthetic joint infection (PJI) following total hip arthroplasty (THA). This meta-analysis aimed to compare the reinfection rate of one-stage revision versus two-stage revision for PJI after THA.MethodsA comprehensive search was performed in four databases (PubMed, Embase, Web of Science, and Cochrane Library) to locate articles that assessed the reinfection rate of one-stage revision compared to two-stage revision. Meta-analyses of reinfection rate were performed.ResultsA total of 14 articles including of 1429 patients were chosen for inclusion in this meta-analysis, with 561 patients in the one-stage group and 868 patients in the two-stage group. The meta-analysis of the 14 trials revealed that there was no statistically significant disparity in the reinfection rate between the two groups(OR = 1.34, 95% CI 0.92 ~ 1.93, P = 0.12, I2 = 0). A subgroup analysis was conducted based on the presence of a well-defined algorithm for decision making in either a one-stage or two-stage revision. There was no statistically significant difference in reinfection rate between one-stage and two-stage revision if there was a decision algorithm(OR = 0.83, 95% CI 0.44 ~ 1.54, P = 0.55, I2 = 0). If not, the reinfection rate of one-stage revision was significantly higher than that of two-stage revision(OR = 1.79, 95% CI 1.11 ~ 2.88, P = 0.02, I2 = 0). Postoperative hip function score was significantly better in the one-stage revision group than that of the two-stage revision group(SMD = 0.54, 95% CI 0.31 ~ 0.78, P<0.05, I2 = 79%).ConclusionsA strategy that is clearly defined and can be used for decision making in one-stage or two-stage revision is necessary for the treatment of PJI after THA. When there is significant damage to the soft tissue and/or the presence of strong microorganisms, a two-stage revision is recommended in order to decrease the reinfection rate. One-stage revision is recommended for patients with low-toxic infections and intact soft tissue.Trial registrationPROSPERO (CRD42023450842, 17 August 2023) https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023450842 .

Project description:ObjectivesA periprosthetic joint infection (PJI) is a significant complication after total knee arthroplasty (TKA). Still there is no agreement on a perfect diagnosis and treatment algorithm. The aim of this study was to evaluate the success and revision rates after two-stage revision total knee arthroplasty (TKA) and factors that affect the success rate.Material and methods50 consecutive two-stage revision TKAs were performed between January 2011 and December 2012. We retrospectively reviewed study patient's charts including demographics, prior surgeries, comorbidities, incidence of persistent infection and revisions. At the final follow-up examination the patient's satisfaction, pain level and disorders were evaluated. A successful clinical outcome was defined as a functioning prosthesis without wound healing disorders, no sinuses tracts or other clinical evidence of a persistent infection. Results : Re-implantation of prosthesis was performed in 47 cases; three patients received a septic arthrodesis. Twelve patients had a persistent infection despite two-stage re-implantation resulting in a success rate of 76.0%. In eight of these twelve patients an infecting germ was isolated during second-stage procedure. Three patients received another two-stage revision arthroplasty and one patient an above knee amputation. A revision was performed in 23 of 50 patients (46.0%). Factors that diminish the success rate were further operations after primary TKA (p = 0.048), prior revision arthroplasties after TKA (p = 0.045), nicotine abuse (p = 0.048), Charlson comorbidity index above a score of 2 (p = 0.031) and a mixed flora during first-stage procedure (p < 0.001). Age, sex, immune status, chronic anticoagulant use, rheumatoid arthritis, body mass index and the presence of multidrug resistant germs showed no significant effect on success rate (p > 0.05). Conclusion : We found that patients who required surgery after the primary TKA, had a higher Charlson comorbidity index or were found to have mixed flora during explantation. The treatment of PJI remains difficult, both for the patient and for the treating surgeons.

Dataset Information

Direct Costs Vary by Outcome in Two-Stage Revision Arthroplasty for the Treatment of Hip Periprosthetic Joint Infection.

Background

Methods

Results

Conclusions

Publications

Direct Costs Vary by Outcome in Two-Stage Revision Arthroplasty for the Treatment of Hip Periprosthetic Joint Infection.

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