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Economic burden of surgical management of surgical site infections following hip and knee replacements in Calgary, Alberta, Canada

Published online by Cambridge University Press:  03 June 2021

Kwadwo Mponponsuo Open the ORCID record for Kwadwo Mponponsuo [Opens in a new window] ,
Jenine Leal ,
Shannon Puloski ,
Derek Chew ,
Swati Chavda ,
Flora Au  and
Elissa Rennert-May
Kwadwo Mponponsuo
Affiliation:
Department of Medicine, University of Calgary, Calgary, Alberta, Canada
Jenine Leal
Affiliation:
Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada Infection Prevention and Control, Alberta Health Services, Alberta, Canada
Shannon Puloski
Affiliation:
Division of Orthopedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
Derek Chew
Affiliation:
Duke University Clinical Research Institute, Durham, North Carolina, United States
Swati Chavda
Affiliation:
Department of Medicine, University of Calgary, Calgary, Alberta, Canada
Flora Au
Affiliation:
Department of Medicine, University of Calgary, Calgary, Alberta, Canada
Elissa Rennert-May*
Affiliation:
Department of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
*
Author for correspondence: Elissa Rennert-May, E-mail: elissa.rennertmay@ucalgary.ca
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Abstract

Objective:

To evaluate the cost of 1-stage and 2-stage revisions, debridement, antibiotic and implant retention (DAIR) and DAIR with liner exchange for complex surgical site infections (SSIs) following hip and knee replacements.

Design:

Retrospective population-based economic analysis of patients undergoing intervention for SSIs between April 1, 2012 and March 31, 2019.

Setting:

The study was conducted in the Calgary zone of Alberta Health Services (AHS) in Canada.

Participants:

Individuals >18 years with complex SSI following hip or knee replacement.

Methods:

Patients with complex SSIs were identified using the AHS infection prevention and control database. A combination of microcosting and gross costing methods were used to estimate 12- and 24-month costs following the initial hospital admission for arthroplasty. Subgroup, inverse Gaussian and γ regression analyses were used to evaluate the impact of age and comorbidities on cost.

Results:

In total, 142 patients with complex SSIs were identified, with a mean age of 66.8 years. Total direct medical costs in United States dollars of 2-stage revisions were ($100,992 (95% CI, 34,587–167,396) at 12 months. The 1-stage revision ($41,176; 95% CI, 23,361–58,991), DAIR with liner exchange ($41,267; 95% CI, 29,923–52,612) and DAIR ($46,605; 95% CI, 15,277–76,844) were associated with fewer costs at 12 months. Age >65 years and chronic complications of diabetes and hypertension were associated with increased costs in subgroup and regression analysis.

Conclusions:

Medical costs are highest at 12 months and for 2-stage revisions in hip and knee complex SSI cases. Further work should explore surgical outcomes correlated with costs to enhance patient care.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 6 , June 2022 , pp. 728 - 735
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

Hip and knee replacements in Canada, 2017–2018: Canadian Joint Replacement Registry Annual Report. Canadian Institute for Health Information website. https://secure.cihi.ca/estore/productFamily.htm?pf=PFC3989&lang=fr&media=0 Published 2019. Accessed April 13, 2021.Google Scholar
Singh, JA, Yu, S, Chen, L, Cleveland, JD. Rates of total joint replacement in the United States: future projections to 2020–2040 using the national inpatient sample. J Rheumatol 2019;46:1134–1140.CrossRefGoogle Scholar
Miletic, KG, Taylor, TN, Martin, ET, Vaidya, R, Kaye, KS. Readmissions after diagnosis of surgical site infection following knee and hip arthroplasty. Infect Control Hosp Epidemiol 2014;35:152–157.CrossRefGoogle ScholarPubMed
Nair, R, Schweizer, ML, Singh, N. Septic arthritis and prosthetic joint infections in older adults. Infect Dis Clin North Am 2017;31:715–729.CrossRefGoogle Scholar
Triffault-Fillit, C, Ferry, T, Laurent, F, et al. Microbiologic epidemiology depending on time to occurrence of prosthetic joint infection: a prospective cohort study. Clin Microbiol Infect 2019;25:353–358.CrossRefGoogle ScholarPubMed
Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute-care setting. Am J Infect Control 2008;36:309–332.CrossRefGoogle ScholarPubMed
Osmon, DR, Berbari, EF, Berendt, AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2013;56:e1–e25.CrossRefGoogle ScholarPubMed
Minassian, AM, Osmon, DR, Berendt, AR. Clinical guidelines in the management of prosthetic joint infection. J Antimicrob Chemother 2014;69 suppl 1:i29–i35.CrossRefGoogle Scholar
Tande, AJ, Gomez-Urena, EO, Berbari, EF, Osmon, DR. Management of prosthetic joint infection. Infect Dis Clin North Am 2017;31:237–252.CrossRefGoogle Scholar
Lange, J, Troelsen, A, Thomsen, RW, Soballe, K. Chronic infections in hip arthroplasties: comparing risk of reinfection following one-stage and two-stage revision: a systematic review and meta-analysis. Clin Epidemiol 2012;4:57–73.CrossRefGoogle Scholar
Kunutsor, SK, Whitehouse, MR, Blom, AW, Beswick, AD, Team, I. Reinfection outcomes following one- and two-stage surgical revision of infected hip prosthesis: a systematic review and meta-analysis. PLoS One 2015;10:e0139166.CrossRefGoogle Scholar
Silvestre, A, Almeida, F, Renovell, P, Morante, E, López, R. Revision of infected total knee arthroplasty: two-stage reimplantation using an antibiotic-impregnated static spacer. Clin Orthop Surg 2013;5:180–187.CrossRefGoogle ScholarPubMed
Tsang, SJ, Ting, J, Simpson, A, Gaston, P. Outcomes following debridement, antibiotics and implant retention in the management of periprosthetic infections of the hip: a review of cohort studies. Bone Joint J 2017;99:1458–1466.CrossRefGoogle ScholarPubMed
Qasim, SN, Swann, A, Ashford, R. The DAIR (debridement, antibiotics and implant retention) procedure for infected total knee replacement—a literature review. Sicot J 2017;3:2.CrossRefGoogle ScholarPubMed
Clement, FM, Ghali, WA, Donaldson, C, Manns, BJ. The impact of using different costing methods on the results of an economic evaluation of cardiac care: microcosting vs gross-costing approaches. Health Econ 2009;18:377–388.CrossRefGoogle Scholar
Consumer price index: annual review, 2019. Statistics Canada website. https://www150.statcan.gc.ca/n1/daily-quotidien/200122/dq200122c-eng.htm. Published 2019. Accessed November 2, 2020.Google Scholar
Charette, RS, Melnic, CM. Two-stage revision arthroplasty for the treatment of prosthetic joint infection. Curr Rev Musculoskelet Med 2018;11:332–340.CrossRefGoogle Scholar
Rowan, FE, Donaldson, MJ, Pietrzak, JR, Haddad, FS. The role of one-stage exchange for prosthetic joint infection. Curr Rev Musculoskelet Med 2018;11:370–379.CrossRefGoogle ScholarPubMed
Sendi, P, Lotscher, PO, Kessler, B, Graber, P, Zimmerli, W, Clauss, M. Debridement and implant retention in the management of hip periprosthetic joint infection: outcomes following guided and rapid treatment at a single centre. Bone Joint J 2017;99:330–336.CrossRefGoogle ScholarPubMed
Klouche, S, Sariali, E, Mamoudy, P. Total hip arthroplasty revision due to infection: a cost analysis approach. Orthop Traumatol Surg Res 2010;96:124–132.CrossRefGoogle ScholarPubMed
Peel, TN, Dowsey, MM, Buising, KL, Liew, D, Choong, PF. Cost analysis of debridement and retention for management of prosthetic joint infection. Clin Microbiol Infect 2013;19:181–186.CrossRefGoogle Scholar
Goodson, KM, Kee, JR, Edwards, PK, et al. Streamlining hospital treatment of prosthetic joint infection. J Arthroplasty. 2020;35:S63–S68.CrossRefGoogle ScholarPubMed
Rennert-May, ED, Conly, J, Smith, S, et al. The cost of managing complex surgical site infections following primary hip and knee arthroplasty: a population-based cohort study in Alberta, Canada. Infect Control Hosp Epidemiol 2018;39:1183–1188.CrossRefGoogle ScholarPubMed
Thompson, JS, Baxter, BT, Allison, JG, Johnson, FE, Lee, KK, Park, WY. Temporal patterns of postoperative complications. Arch Surg 2003;138:596–603.CrossRefGoogle ScholarPubMed
Hartzler, MA, Li, K, Geary, MB, Odum, SM, Springer, BD. Complications in the treatment of prosthetic joint infection. Bone Joint J 2020;102:145–150.CrossRefGoogle Scholar
Bozic, KJ, Stacey, B, Berger, A, Sadosky, A, Oster, G. Resource utilization and costs before and after total joint arthroplasty. BMC Health Serv Res 2012;12:73.CrossRefGoogle Scholar
Wang, J, Chen, K, Li, X, et al. Postoperative adverse events in patients with diabetes undergoing orthopedic and general surgery. Medicine 2019;98:e15089.CrossRefGoogle ScholarPubMed
Khan, NA, Quan, H, Bugar, JM, Lemaire, JB, Brant, R, Ghali, WA. Association of postoperative complications with hospital costs and length of stay in a tertiary-care center. J Gen Intern Med 2006;21:177–180.CrossRefGoogle Scholar
Visser, A, Geboers, B, Gouma, DJ, Goslings, JC, Ubbink, DT. Predictors of surgical complications: a systematic review. Surgery 2015;158:58–65.CrossRefGoogle ScholarPubMed
Cahill, JL, Shadbolt, B, Scarvell, JM, Smith, PN. Quality of life after infection in total joint replacement. J Orthop Surg 2008;16:58–65.CrossRefGoogle ScholarPubMed
Masters, JPM, Smith, NA, Foguet, P, Reed, M, Parsons, H, Sprowson, AP. A systematic review of the evidence for single stage and two stage revision of infected knee replacement. BMC Musculoskel Dis 2013;14:222.CrossRefGoogle ScholarPubMed
Barros, LH, Barbosa, TA, Esteves, J, Abreu, M, Soares, D, Sousa, R. Early debridement, antibiotics and implant retention (DAIR) in patients with suspected acute infection after hip or knee arthroplasty—safe, effective and without negative functional impact. J Bone Jt Infect 2019;4:300–305.CrossRefGoogle ScholarPubMed
Rennert-May, E, Bush, K, Vickers, D, Smith, S. Use of a provincial surveillance system to characterize postoperative surgical site infections after primary hip and knee arthroplasty in Alberta, Canada. Am J Infect Control 2016;44:1310–1314.CrossRefGoogle ScholarPubMed
Rennert-May, E, Conly, J, Smith, S, et al. A cost-effectiveness analysis of mupirocin and chlorhexidine gluconate for Staphylococcus aureus decolonization prior to hip and knee arthroplasty in Alberta, Canada, compared to standard of care. Antimicrob Resist Infect Control 2019;8:113.CrossRefGoogle Scholar
Solarino, G, Abate, A, Vicenti, G, Spinarelli, A, Piazzolla, A, Moretti, B. Reducing periprosthetic joint infection: what really counts? Joints 2016;3:208–214.Google ScholarPubMed
Matharu, GS, Garriga, C, Rangan, A, Judge, A. Does regional anesthesia reduce complications following total hip and knee replacement compared with general anesthesia? An analysis from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. J Arthroplasty 2020;35:1521–1528.CrossRefGoogle Scholar
Kremers, K, Leijtens, B, Camps, S, Tostmann, A, Koëter, S, Voss, A. Evaluation of early wound leakage as a risk factor for prosthetic joint infection. J Am Assoc Nurse Pract 2019;31:337–343.CrossRefGoogle ScholarPubMed