Total hip arthroplasty revision due to infection: A cost analysis approach

Klouche, Shahnaz; Sariali, Elhadi; Mamoudy, P.

doi:10.1016/j.otsr.2009.11.004

Cited by 226 publications

(190 citation statements)

References 2 publications

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“…Treatment failures are not only costly, but also are associated with substantial morbidity and mortality [1,3,6,8,12] Although two-stage exchange arthroplasty remains a commonly used treatment approach, it remains imperfect. Studies have reported success rates approaching 90%, whereas others have reported less successful outcomes [7].…”

Section: Discussionmentioning

confidence: 99%

The Mark Coventry, MD, Award: Oral Antibiotics Reduce Reinfection After Two-Stage Exchange: A Multicenter, Randomized Controlled Trial

Frank

Kayupov

Moric

et al. 2017

Clinical Orthopaedics &Amp; Related Research

117

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Background Many patients develop recurrent periprosthetic joint infection after two-stage exchange arthroplasty of the hip or knee. One potential but insufficiently tested strategy to decrease the risk of persistent or recurrent infection is to administer additional antibiotics after the second-stage reimplantation. Questions/purposes (1) Does a 3-month course of oral antibiotics decrease the risk of failure secondary to infection after a two-stage exchange? (2) Are there any complications related to the administration of oral antibiotics after a two-stage exchange? (3) In those patients who develop a reinfection, is the infecting organism different from the initial infection? Methods Patients at seven centers randomized to receive 3 months of oral antibiotics or no further antibiotic treatment after operative cultures after the second-stage reimplantation were negative. Adult patients undergoing

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Section: Discussionmentioning

confidence: 99%

The Mark Coventry, MD, Award: Oral Antibiotics Reduce Reinfection After Two-Stage Exchange: A Multicenter, Randomized Controlled Trial

Frank

Kayupov

Moric

et al. 2017

Clinical Orthopaedics &Amp; Related Research

117

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“…A recent cost-analysis study in France found that costs of septic revisions were 3.6 times higher following a THA than following a primary THA, mainly because of longer hospitalisation periods and rehabilitation after hospital discharge. 41 The treatment or revision of an infected joint can be very time-consuming and resource intensive. 42,43 Costs of SSIs usually increase with the depth of infection (i.e.…”

Section: Permanent Resectionmentioning

confidence: 99%

“…38 The economic burden of SSI after hip arthroplasty was reported to increase health-care costs by more than 300%, but dollar estimates differ widely, from US$400 to US$60,000 per SSI treated. 5,38,41,44,45 Apart from obvious reasons for the wide range of estimated costs, such as severity of infection or differing hospital fees in different countries, there is no consistent methodology used to calculate costs of infection. 46 The measurement of cost requires identifying the quantity of resource use and the unit costs or prices for using the resources.…”

Section: Permanent Resectionmentioning

confidence: 99%

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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“…However, there has been a lack of consensus on the type of spacer that should be implanted, as well as the antibiotic and its concentration that should be incorporated into these spacers. The infection control rates that have been associated with the various types of available spacers and their indications need to be defined in order to help maximize rates of infection control, while minimizing cost and hospitalization lengths [10].…”

Section: Introductionmentioning

confidence: 99%

Does a Prefabricated Gentamicin-impregnated, Load-bearing Spacer Control Periprosthetic Hip Infection?

Degen

Davey

Howard

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Introduction Treating deep infection following THA has been a challenge. While the standard treatment has remained a two-stage revision, spacer designs, incorporated antibiotics, and concentrations have varied. Since control of infection may relate to choice and concentration of antibiotics, it is important to report rates of control from various spacers. Questions/purposes We therefore determined (1) the rate of infection control and (2) complications associated with a prefabricated, load-bearing, gentamicinimpregnated hip spacer in treating periprosthetic infections of the hip. Methods We retrospectively reviewed 33 patients with periprosthetic THA infections treated with a prefabricated, partial load-bearing, gentamicin-impregnated hemiarthroplasty spacer. Thirty of the 33 patients underwent second stage reimplantation after a mean 15 weeks. We collected patient demographic data, laboratory values, infecting organism, size of spacer mold, antibiotic selection, complications, and infection control rates from two academic centers. Recurrent infection at last followup was determined by the presence of physical symptoms or signs or elevated serologic tests. The minimum followup was 24 months (mean, 43 months; range, 24-70 months).

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Total hip arthroplasty revision due to infection: A cost analysis approach

Abstract: Level IV. Economic and decision analyses, retrospective study

Cited by 226 publications

References 2 publications

The Mark Coventry, MD, Award: Oral Antibiotics Reduce Reinfection After Two-Stage Exchange: A Multicenter, Randomized Controlled Trial

The Mark Coventry, MD, Award: Oral Antibiotics Reduce Reinfection After Two-Stage Exchange: A Multicenter, Randomized Controlled Trial

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

Does a Prefabricated Gentamicin-impregnated, Load-bearing Spacer Control Periprosthetic Hip Infection?

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