Comparison of Health Care Costs Between Aseptic and Two Stage Septic Hip Revision

Assmann, Grit; Kasch, Richard; Maher, Christopher G.; Hofer, André; Barz, Thomas; Merk, H.; Fleßa, Steffen

doi:10.1016/j.arth.2014.04.043

Cited by 25 publications

(23 citation statements)

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“…3, 17487 Greifswald) approved the study (BB 010/13) and waived written informed consent, without restrictions on data. In the methods section we followed previously published protocols, describing in detail design, patient selection, outcome measures and the calculation of costs [24,30]. All patients (n = 106) undergoing revision TKA were treated in a university hospital providing primary medical care and specialized procedures in the period of 39 months ending Jan. 1, 2012.…”

Section: Methodsmentioning

confidence: 99%

“…Since our aim was to analyze all aseptic as well as septic revision TKA´s performed, no case exclusion was done in this consecutive study. Following international guidelines, and cost studies of the hip published before [30], patients were included when (1) they had an ICD-10 (International Classification of Diseases) indication for TKA revision according to Code T84.0 (aseptic—mechanical complication of internal joint prosthesis) or T84.5 (septic—infection and inflammatory reaction due to internal joint prosthesis) and (2) underwent procedures with OPS (Operation and Procedure) Codes 5–823 (Re-operation, exchange or removal of an artificial knee joint) and 5–822 (Implantation of an artificial knee joint) [37,38]. The inclusion of patients with aseptic/septic failure was based on the presence of: (1) typical clinical signs and symptoms in the leg; (2) imaging confirmation of loosening including x-rays and scintigraphy; and (3) characteristic laboratory and pathophysiologic values in blood [39,40].…”

Section: Methodsmentioning

confidence: 99%

“…When the electronic patient file was incomplete or inconsistent with regard to eligibility, or patient outcome, we additionally retrieved the paper files from the hospital’s archive to obtain more data [24,30]”.…”

Section: Methodsmentioning

confidence: 99%

“…Following Assmann et al and Kasch et al patient demographics (age, gender), clinical measures (pathogens, length of stay, operative time, number of comorbidities, extent of revision), consumption of hospital resources, and economic data were retrospectively evaluated case-by-case [24,30]. Following international guidelines septic TKA revisions are performed as two-stage procedures with two hospital stays, which we analyzed separately (septic explantation versus septic implantation) [17,18].…”

Section: Methodsmentioning

confidence: 99%

“…To the best of our knowledge, all published cost studies of revision TKA, unlike those of aseptic and septic total hip revision, use a total cost approach [29–31], which provides no basis for economic decisions for the department performing this kind of surgery [15,26,32–36]. In contrast, the partial cost approach we present here and have already used for a similar study of hip replacement distinguishes variable from case-fixed costs [30]. It thus contributes essential data for making future management decisions in hospital departments.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

et al. 2017

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BackgroundThe most common intermediate and long-term complications of total knee arthroplasty (TKA) include aseptic and septic failure of prosthetic joints. These complications cause suffering, and their management is expensive. In the future the number of revision TKA will increase, which involves a greater financial burden. Little concrete data about direct costs for aseptic and two-stage septic knee revisions with an in depth-analysis of septic explantation and implantation is available.Questions/PurposesA retrospective consecutive analysis of the major partial costs involved in revision TKA for aseptic and septic failure was undertaken to compare 1) demographic and clinical characteristics, and 2) variable direct costs (from a hospital department’s perspective) between patients who underwent single-stage aseptic and two-stage septic revision of TKA in a hospital providing maximum care. We separately analyze the explantation and implantation procedures in septic revision cases and identify the major cost drivers of knee revision operations.MethodsA total of 106 consecutive patients (71 aseptic and 35 septic) was included. All direct costs of diagnosis, surgery, and treatment from the hospital department’s perspective were calculated as real purchase prices. Personnel involvement was calculated in units of minutes.ResultsAseptic versus septic revisions differed significantly in terms of length of hospital stay (15.2 vs. 39.9 days), number of reported secondary diagnoses (6.3 vs. 9.8) and incision-suture time (108.3 min vs. 193.2 min). The management of septic revision TKA was significantly more expensive than that of aseptic failure ($12,223.79 vs. $6,749.43) (p <.001).On the level of the separate hospitalizations the mean direct costs of explantation stage ($4,540.46) were lower than aseptic revision TKA ($6,749.43) which were again lower than those of the septic implantation stage ($7,683.33). All mean costs of stays were not comparable as they differ significantly (p <.001). Major cost drivers were the cost of the implant and general staff. The septic implantation part was on average $3,142.87 more expensive than septic explantations (p <.001).ConclusionsOur study for the first time provides a detailed analysis of the major direct case costs of aseptic and septic revision TKA from the hospital-department’s perspective which is the basis for long-term orientated decision making. In the future, our cost analysis has to be interpreted in relation to reimbursement estimates. This is important to check whether revision TKA lead to a financial loss for the operating department.

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Section: Methodsmentioning

confidence: 99%