Financial analysis of revision knee surgery based on NHS tariffs and hospital costs

Kallala, Rami; Vanhegan, Ivor; Ibrahim, Mazin; Sarmah, SS; Haddad, Fares S.

doi:10.1302/0301-620x.97b2.33707

Cited by 181 publications

(119 citation statements)

References 26 publications

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“…These costs exceed the average costs for revision surgery of £25.974. [23, 24] Including societal costs by assuming that 50% of patients would be absent from work for 8 weeks because of the revision, amounting to £1.400 per week, costs in Australia and Europe were still considerably (£378.667 and £332.292 respectively) higher than the costs for revision surgery. Assuming a threshold of £30.000 per Quality Adjusted Life Years (QALY) for a cost-effective intervention, this would mean that 12,6 QALY’s have to be gained by preventing revisions, for the Australian strategy to be cost-effective compared to the US (11,1 QALY’s for Europe).…”

Section: Discussionmentioning

confidence: 99%

Variation in Prosthetic Joint Infection and treatment strategies during 4.5 years of follow-up after primary joint arthroplasty using administrative data of 41397 patients across Australian, European and United States hospitals

Mheen

Turner

Liew

et al. 2017

BMC Musculoskelet Disord

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BackgroundTo identify best practices and quality improvement initiatives, we aimed to assess whether the incidence of Periprosthetic Joint Infection (PJI) and treatment strategies differed across patients treated in Australian, European and United States (US) hospitals.MethodsRoutinely collected administrative data for 41397 patients undergoing a primary total hip or knee arthroplasty between July 2007-December 2010 across 22 hospitals were included. Patients were followed for 2 years looking for PJI occurrence, defined as early (within 4 weeks) and late PJI, and surgical treatment during 2.5 years after PJI diagnosis. Logistic and Poisson regression models were used to test for differences in PJI occurrence and treatment strategies across the three geographical regions, adjusted for age, sex, joint and Elixhauser comorbidity groups.ResultsPJI occurrence varied from 1.4% in European to 1.7% in Australian patients, which were significantly higher than US patients after adjustment for patient characteristics (OR 1.24 [1.01–1.52] and 1.40 [1.03–1.91] respectively). Early PJIs varied between 0.3% in European to 0.6% in Australian patients, but adjusted rates were similar. Revision following PJI was significantly lower in Australian than in US patients (OR 0.46 [0.25–0.86]) as were the total number of revisions (RR 0.51 [0.36–0.71]) and number of surgical procedures (RR 0.60 [0.44–0.81]) used to treat PJI.ConclusionThe overall PJI rate was significantly higher in Australian patients, but fewer procedures were needed to treat these PJIs. Future research should reveal whether this reflects PJIs caught earlier or less severe when diagnosed, and whether this is associated with the longer length of stay after primary arthroplasty in Australian hospitals.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1569-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Variation in Prosthetic Joint Infection and treatment strategies during 4.5 years of follow-up after primary joint arthroplasty using administrative data of 41397 patients across Australian, European and United States hospitals

Mheen

Turner

Liew

et al. 2017

BMC Musculoskelet Disord

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“…Two studies estimated revision costs for infected prosthetics: for infected hip arthroplasties, estimated costs were £22,000 51 and for infected knees, estimated costs were £30,000. 52 These costs included the revision surgery and subsequent inpatient stay. 29 A 2013 review summarised the economic literature in the treatment of periprosthetic joint infections, looking at prevention, treatment and surgical options.…”

Section: Health Economicsmentioning

confidence: 99%

Oral versus intravenous antibiotics for bone and joint infections: the OVIVA non-inferiority RCT

Scarborough

Rombach

et al. 2019

Health Technol Assess

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Background Management of bone and joint infection commonly includes 4–6 weeks of intravenous (IV) antibiotics, but there is little evidence to suggest that oral (PO) therapy results in worse outcomes. Objective To determine whether or not PO antibiotics are non-inferior to IV antibiotics in treating bone and joint infection. Design Parallel-group, randomised (1 : 1), open-label, non-inferiority trial. The non-inferiority margin was 7.5%. Setting Twenty-six NHS hospitals. Participants Adults with a clinical diagnosis of bone, joint or orthopaedic metalware-associated infection who would ordinarily receive at least 6 weeks of antibiotics, and who had received ≤ 7 days of IV therapy from definitive surgery (or start of planned curative treatment in patients managed non-operatively). Interventions Participants were centrally computer-randomised to PO or IV antibiotics to complete the first 6 weeks of therapy. Follow-on PO therapy was permitted in either arm. Main outcome measure The primary outcome was the proportion of participants experiencing treatment failure within 1 year. An associated cost-effectiveness evaluation assessed health resource use and quality-of-life data. Results Out of 1054 participants (527 in each arm), end-point data were available for 1015 (96.30%) participants. Treatment failure was identified in 141 out of 1015 (13.89%) participants: 74 out of 506 (14.62%) and 67 out of 509 (13.16%) of those participants randomised to IV and PO therapy, respectively. In the intention-to-treat analysis, using multiple imputation to include all participants, the imputed risk difference between PO and IV therapy for definitive treatment failure was –1.38% (90% confidence interval –4.94% to 2.19%), thus meeting the non-inferiority criterion. A complete-case analysis, a per-protocol analysis and sensitivity analyses for missing data each confirmed this result. With the exception of IV catheter complications [49/523 (9.37%) in the IV arm vs. 5/523 (0.96%) in the PO arm)], there was no significant difference between the two arms in the incidence of serious adverse events. PO therapy was highly cost-effective, yielding a saving of £2740 per patient without any significant difference in quality-adjusted life-years between the two arms of the trial. Limitations The OVIVA (Oral Versus IntraVenous Antibiotics) trial was an open-label trial, but bias was limited by assessing all potential end points by a blinded adjudication committee. The population was heterogenous, which facilitated generalisability but limited the statistical power of subgroup analyses. Participants were only followed up for 1 year so differences in late recurrence cannot be excluded. Conclusions PO antibiotic therapy is non-inferior to IV therapy when used during the first 6 weeks in the treatment for bone and joint infection, as assessed by definitive treatment failure within 1 year of randomisation. These findings challenge the current standard of care and provide an opportunity to realise significant benefits for patients, antimicrobial stewardship and the health economy. Future work Further work is required to define the optimal total duration of therapy for bone and joint infection in the context of specific surgical interventions. Currently, wide variation in clinical practice suggests significant redundancy that likely contributes to the excess and unnecessary use of antibiotics. Trial registration Current Controlled Trials ISRCTN91566927. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 38. See the NIHR Journals Library website for further project information.

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“…[2] Bu da ülke ekonomilerine maliyet artışı olarak yansımaktadır. [8] Ortopedistlere TDA ve TKA uygulamalarında komplikasyonlardan korunma, ameliyathane koşul-ları, enfeksiyonların tanı ve tedavisi ile ilgili belli aralıkla yeni algoritmalar sunulmaktadır. [9] Ancak bu algoritmaları uygulamada ortopedistlerin deneyimleri ve çalıştıkları hastane olanakları gibi etmenler nedeniyle farklı tutumlar ortaya çıkmakta ve çalışmalara konu olmaktadır.…”

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Preferences of surgeons in total knee and hip arthroplasty, and operating room facilities in Turkey: a survey

Azboy¹

2016

Eklem Hastalik Cerrahisi

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ÖZAmaç: Bu çalışmada Türkiye'de total diz artroplastisi (TDA) ve total kalça artroplastisinde (TKA) ortopedik cerrahların ameliyat öncesi ve sonrası yaklaşımları ve ameliyathane olanakları değerlendirildi. Gereç ve yöntemler: Bu çalışmanın verileri Türk Ortopedi ve Travmatoloji Birliği Derneği'nin veri tabanından rastgele belirlenen 234 hekim tarafından doldurulan bir anket aracılığıyla elde edildi. Anket; ameliyathane ortamını, cerrahların demografik özelliklerini, ameliyat öncesi ve sonrası hasta değerlendirmesinde istedikleri laboratuvar ve radyolojik incelemeleri ve ameliyat sonrası komplikasyonların yönetimini araştıran 19 sorudan oluşuyordu. Bulgular: Türkiye'deki TDA ve TKA'nın uygulandığı ameliyathanelerin %48'inde laminar hava akımı, %35'inde de HEPA filtre bulunmamaktadır. Cerrahların sadece %20.5'i antibiyotik profilaksisine ameliyat sonrası 24 saat devam etmektedir. Tromboembolizm profilaksisinde en çok (%86) tercih edilen antikoagülan düşük moleküler ağırlıklı heparinlerdir. Cerrahların tamamı primer TDA veya TKA uygularken, sadece %63.7'si revizyon TDA veya TKA uygulamaktadır. Cerrahların %84.6'sı TDA veya TKA uygulanan hastalarda dental ve ürolojik girişimler öncesinde antibiyotik profilaksisi önermemektedir. Sonuç: Türkiye'de TDA ve TKA'ya ilişkin birçok konuda görüş birliğine ulaşılmış olsa da; akademik pozisyon, uzmanlık süresi ve çalışılan kuruma bağlı olarak farklı yaklaşımlar benimsenmektedir.Anahtar sözcükler: Profilaksi; anket; total kalça artroplastisi; total diz artroplastisi. ABSTRACTObjectives: This study aims to determine the pre-and postoperative approaches of orthopedic surgeons and operative room environment facilities in total knee arthroplasty (TKA) and total hip arthroplasty (THA) in Turkey. Materials and methods: Data for this study were collected through a questionnaire completed by 234 physicians randomly identified from the database of Turkish Society of Orthopedics and Traumatology. The questionnaire comprised 19 questions investigating the operative room environment, demographic characteristics of surgeons, laboratory and radiologic analyses required by surgeons in pre-and postoperative patient evaluation, and management of postoperative complications. Results: In Turkey, 48% of the operating rooms where TKA and THA are performed lack laminar airflow, while 35% lack HEPA filters. Only 20.5% of surgeons continue antibiotic prophylaxis for postoperative 24 hours. Low molecular weight heparins are the most preferred anticoagulant (86%) for thromboembolism prophylaxis. While all surgeons perform primary TKA or THA, only 63.7% perform revision TKA or THA. Of the surgeons, 84.6% do not recommended antibiotic prophylaxis before dental or urologic procedures in patients who were performed TKA or THA. Conclusion: In Turkey, although consensus has been built on many issues regarding TKA and THA, different approaches are adopted based on academic position, duration of specialty, and employer institution.

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Financial analysis of revision knee surgery based on NHS tariffs and hospital costs

Cited by 181 publications

References 26 publications

Variation in Prosthetic Joint Infection and treatment strategies during 4.5 years of follow-up after primary joint arthroplasty using administrative data of 41397 patients across Australian, European and United States hospitals

Variation in Prosthetic Joint Infection and treatment strategies during 4.5 years of follow-up after primary joint arthroplasty using administrative data of 41397 patients across Australian, European and United States hospitals

Oral versus intravenous antibiotics for bone and joint infections: the OVIVA non-inferiority RCT

Preferences of surgeons in total knee and hip arthroplasty, and operating room facilities in Turkey: a survey

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