A financial analysis of revision hip arthroplasty

Vanhegan, Ivor; Malik, Ahmad Kamran; Jayakumar, Prakash; Islam, Saif Ul; Haddad, Fares S.

doi:10.1302/0301-620x.94b5.27073

Cited by 270 publications

(100 citation statements)

References 27 publications

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“…The cost of a single revision surgery for PJI is higher than the cost of revision for noninfectious reasons, with postulated reasons including prolonged procedure duration, increased blood loss, increased use of bone allograft, and increased complications (14). More complicated treatment strategies involving multiple individual surgeries further increase this cost compared to the cost of only a single surgery.…”

Section: Economic Impactmentioning

confidence: 99%

Prosthetic Joint Infection

2014

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SUMMARY Prosthetic joint infection (PJI) is a tremendous burden for individual patients as well as the global health care industry. While a small minority of joint arthroplasties will become infected, appropriate recognition and management are critical to preserve or restore adequate function and prevent excess morbidity. In this review, we describe the reported risk factors for and clinical manifestations of PJI. We discuss the pathogenesis of PJI and the numerous microorganisms that can cause this devastating infection. The recently proposed consensus definitions of PJI and approaches to accurate diagnosis are reviewed in detail. An overview of the treatment and prevention of this challenging condition is provided.

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Section: Economic Impactmentioning

confidence: 99%

Prosthetic Joint Infection

2014

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“…Orthopaedic SSI has been reported to increase the mortality risk by 50% and the hospital stay by, on average, 11.5-14 days and to double the rehospitalisation rates. 4,5,39 A UK study by Vanhegan et al 40 compared the costs of revision operations for aseptic loosening, dislocation, deep infection and periprosthetic fracture. Clinical, demographic and economic data were collected for 305 consecutive-revision THRs in 286 patients in a single tertiary referral unit.…”

Section: Permanent Resectionmentioning

confidence: 99%

“…41 They found that in their institution, the average hospital stay was 7.5 days for primary THA and 30.6 days for revisions because of infection. Vanhegan et al 40 compared the costs of revision operations for aseptic loosening, dislocation, deep infection and periprosthetic fracture. Clinical, demographic and economic data were collected for 305 consecutive revision THRs in 286 patients in a single tertiary referral unit.…”

Section: Background and Study Objectivesmentioning

confidence: 99%

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A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review

Graves

Wloch

Wilson

et al. 2016

Health Technol Assess

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BackgroundA deep infection of the surgical site is reported in 0.7% of all cases of total hip arthroplasty (THA). This often leads to revision surgery that is invasive, painful and costly. A range of strategies is employed in NHS hospitals to reduce risk, yet no economic analysis has been undertaken to compare the value for money of competing prevention strategies.ObjectivesTo compare the costs and health benefits of strategies that reduce the risk of deep infection following THA in NHS hospitals. To make recommendations to decision-makers about the cost-effectiveness of the alternatives.DesignThe study comprised a systematic review and cost-effectiveness decision analysis.Setting77,321 patients who had a primary hip arthroplasty in NHS hospitals in 2012.InterventionsNine different treatment strategies including antibiotic prophylaxis, antibiotic-impregnated cement and ventilation systems used in the operating theatre.Main outcome measuresChange in the number of deep infections, change in the total costs and change in the total health benefits in quality-adjusted life-years (QALYs).Data sourcesLiterature searches using MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials were undertaken to cover the period 1966–2012 to identify infection prevention strategies. Relevant journals, conference proceedings and bibliographies of retrieved papers were hand-searched. Orthopaedic surgeons and infection prevention experts were also consulted.Review methodsEnglish-language papers only. The selection of evidence was by two independent reviewers. Studies were included if they were interventions that reported THA-related deep surgical site infection (SSI) as an outcome. Mixed-treatment comparisons were made to produce estimates of the relative effects of competing infection control strategies.ResultsTwelve studies, six randomised controlled trials and six observational studies, involving 123,788 total hip replacements (THRs) and nine infection control strategies, were identified. The quality of the evidence was judged against four categories developed by the National Institute for Health and Care ExcellenceMethods for Development of NICE Public Health Guidance(http://publications.nice.org.uk/methods-for-the-development-of-nice-public-health-guidance-third-edition-pmg4), accessed March 2012. All evidence was found to fit the two highest categories of 1 and 2. Nine competing infection control interventions [treatments (Ts) 1–9] were used in a cohort simulation model of 77,321 patients who had a primary THR in 2012. Predictions were made for cases of deep infection and total costs, and QALY outcomes. Compared with a baseline of T1 (no systemic antibiotics, plain cement and conventional ventilation) all other treatment strategies reduced risk. T6 was the most effective (systemic antibiotics, antibiotic-impregnated cement and conventional ventilation) and prevented a further 1481 cases of deep infection, and led to the largest annual cost savings and the greatest gains to QALYs. The additional uses of laminar airflow and body exhaust suits indicate higher costs and worse health outcomes.ConclusionsT6 is an optimal strategy for reducing the risk of SSI following THA. The other strategies that are commonly used among NHS hospitals lead to higher cost and worse QALY outcomes. Policy-makers, therefore, have an opportunity to save resources and improve health outcomes. The effects of laminar air flow and body exhaust suits might be further studied if policy-makers are to consider disinvesting in these technologies.LimitationsA wide range of evidence sources was synthesised and there is large uncertainty in the conclusions.FundingThe National Institute for Health Research Health Technology Assessment programme and the Queensland Health Quality Improvement and Enhancement Programme (grant number 2008001769).

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“…Although orthopedic deviceassociated infections (ODAI) are uncommon, occurring in only 1 to 2% of patients with hip and knee replacements and up to 6% of patients after internal fixation of closed fractures, their management is difficult (1). Management can require multiple revision surgeries and prolonged antibiotic treatment, may result in permanent disabilities, and is associated with high costs (2,3).…”

mentioning

confidence: 99%

Optimal Culture Incubation Time in Orthopedic Device-Associated Infections: a Retrospective Analysis of Prolonged 14-Day Incubation

et al. 2014

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Accurate diagnosis of orthopedic device-associated infections can be challenging. Culture of tissue biopsy specimens is often considered the gold standard; however, there is currently no consensus on the ideal incubation time for specimens. The aim of our study was to assess the yield of a 14-day incubation protocol for tissue biopsy specimens from revision surgery (joint replacements and internal fixation devices) in a general orthopedic and trauma surgery setting. Medical records were reviewed retrospectively in order to identify cases of infection according to predefined diagnostic criteria. From August 2009 to March 2012, 499 tissue biopsy specimens were sampled from 117 cases. In 70 cases (59.8%), at least one sample showed microbiological growth. Among them, 58 cases (82.9%) were considered infections and 12 cases (17.1%) were classified as contaminations. The median time to positivity in the cases of infection was 1 day (range, 1 to 10 days), compared to 6 days (range, 1 to 11 days) in the cases of contamination (P < 0.001). Fifty-six (96.6%) of the infection cases were diagnosed within 7 days of incubation. In conclusion, the results of our study show that the incubation of tissue biopsy specimens beyond 7 days is not productive in a general orthopedic and trauma surgery setting. Prolonged 14-day incubation might be of interest in particular situations, however, in which the prevalence of slow-growing microorganisms and anaerobes is higher.

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A financial analysis of revision hip arthroplasty

Cited by 270 publications

References 27 publications

Prosthetic Joint Infection

Prosthetic Joint Infection

A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review

Optimal Culture Incubation Time in Orthopedic Device-Associated Infections: a Retrospective Analysis of Prolonged 14-Day Incubation

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