Tufts Medical Center, Department of Orthopaedic Surgery, Boston, MA.
Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR.
J Arthroplasty. 2021 Feb;36(2):700-704. doi: 10.1016/j.arth.2020.08.045. Epub 2020 Aug 27.
Routine preoperative allergy testing in patients reporting penicillin and cephalosporin allergies increases the number able to receive cefazolin, which should reduce the risk of infection after total knee and hip arthroplasty (TKA/THA), but it remains unclear whether this practice is cost-effective. Using a break-even analysis, we calculated the cost-effectiveness of routine preoperative allergy testing for infection prevention in total joint arthroplasty patients reporting penicillin and cephalosporin allergies.
The cost of a penicillin allergy evaluation, the cost of revision arthroplasty for prosthetic joint infection (PJI), and baseline rates of PJI in patients receiving a noncefazolin antibiotic in the perioperative period were derived from existing literature. A break-even economic model using these variables was constructed to calculate the absolute risk reduction (ARR) in infection rate needed for preoperative allergy testing to be cost-effective. The number needed to treat (NNT) was calculated from the ARR.
Preoperative allergy testing before TKA and THA in patients reporting penicillin and cephalosporin allergies was cost-effective if the initial infection rate decreased by an ARR of 0.810% (NNT = 123) and 0.655% (NNT = 153) for TKA and THA, respectively. Cost-effectiveness was maintained with varying allergy consultation costs, infection rates, and costs associated with PJI treatment.
Routine preoperative allergy testing and clearance are cost-effective infection prevention strategies among patients reporting penicillin and cephalosporin allergies in the setting of elective joint arthroplasty. Widespread adoption of this practice may considerably reduce the economic and societal burden associated with prosthetic infections.
在报告青霉素和头孢菌素过敏的患者中进行常规术前过敏测试，可以增加能够接受头孢唑林的患者数量，这应该会降低全膝关节和髋关节置换术（TKA/THA）后的感染风险，但这种做法是否具有成本效益仍不清楚。我们使用盈亏平衡分析，计算了在报告青霉素和头孢菌素过敏的全关节置换术患者中，常规术前过敏测试预防感染的成本效益。
从现有文献中得出了青霉素过敏评估的成本、因假体关节感染（PJI）而进行翻修关节置换术的成本，以及在围手术期接受非头孢唑林抗生素的患者中 PJI 的基线发生率。使用这些变量构建了一个盈亏平衡经济模型，以计算术前过敏测试在感染率方面具有成本效益所需的绝对风险降低（ARR）。ARR 计算出需要治疗的人数（NNT）。
在报告青霉素和头孢菌素过敏的 TKA 和 THA 患者中，术前过敏测试在以下情况下具有成本效益：ARR 为 0.810%（NNT=123）和 0.655%（NNT=153）时，TKA 和 THA 的初始感染率分别降低。随着过敏咨询费用、感染率和 PJI 治疗相关成本的变化，成本效益得以维持。
在择期关节置换术的背景下，对于报告青霉素和头孢菌素过敏的患者，常规术前过敏测试和清除是一种具有成本效益的感染预防策略。广泛采用这种做法可能会大大降低与假体感染相关的经济和社会负担。
