Wagner Eric R, Ransom Jeanine E, Kremers Hilal Maradit, Morrey Mark, Sanchez-Sotelo Joaquin
Department of Orthopedic Surgery, Mayo Clinic, SW Rochester, MN, USA.
Shoulder Elbow. 2017 Oct;9(4):279-284. doi: 10.1177/1758573217706364. Epub 2017 May 8.
The purpose of the present study was to determine the cost of two-stage reimplantation for the treatment of deep infection after total elbow arthroplasty (TEA) and compare this with primary and aseptic revision TEA.
Three hundred and seventy-one primary TEA and 286 revision TEAs (including 47 elbows requiring two-stage reimplantation) were performed. Total direct medical costs during each hospitalization were obtained from our institutional research database and compared for three groups: primary TEA, revision for nonseptic reasons and two-stage reimplantation for deep infection.
The mean cost of an uncomplicated primary TEA and aseptic revision TEA was $18,464 and $18,796, respectively. The mean overall cost associated with two-stage reimplantation increased to $34,286. Two-stage reimplantation increased both Part A (hospital costs) and Part B (professional costs). The mean Part A cost for septic revision TEA was $29,102 versus $15,844 for primary TEA. The mean Part B cost for septic revision TEA was $5,184 versus $2,621 for primary TEA.
Two-stage reimplantation for treatment of an infected TEA costs 186% the hospital cost of a primary uncomplicated or aseptic revision TEA. The overall cost to society is even greater if we take into account the cost of antibiotic therapy in between stages and lost days from work.
本研究的目的是确定全肘关节置换术（TEA）后深部感染的两阶段再植入治疗成本，并将其与初次和无菌翻修TEA进行比较。
共进行了371例初次TEA和286例翻修TEA（包括47例需要两阶段再植入的肘关节）。每次住院期间的总直接医疗费用从我们机构的研究数据库中获取，并对三组进行比较：初次TEA、非感染性原因翻修和深部感染的两阶段再植入。
单纯初次TEA和无菌翻修TEA的平均成本分别为18464美元和18796美元。两阶段再植入的平均总成本增至34286美元。两阶段再植入增加了A部分（医院费用）和B部分（专业费用）。感染性翻修TEA的平均A部分成本为29102美元，而初次TEA为15844美元。感染性翻修TEA的平均B部分成本为5184美元，而初次TEA为2621美元。
治疗感染性TEA的两阶段再植入成本是初次非复杂或无菌翻修TEA医院成本的186%。如果考虑到两阶段之间的抗生素治疗成本和工作损失天数，对社会的总体成本甚至更高。
