手术治疗人工关节周围髋关节和膝关节感染的直接住院医疗费用是无菌翻修手术的两倍。

Direct Inpatient Medical Costs of Operative Treatment of Periprosthetic Hip and Knee Infections Are Twofold Higher Than Those of Aseptic Revisions.

机构信息

Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington.

Departments of Orthopedic Surgery (M.H., D.G.L., D.J.B., and H.M.K.) and Health Sciences Research (S.L.V., J.E.R., and H.M.K.), Mayo Clinic, Rochester, Minnesota.

出版信息

J Bone Joint Surg Am. 2021 Feb 17;103(4):312-318. doi: 10.2106/JBJS.20.00550.

DOI:10.2106/JBJS.20.00550

PMID:33252589

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8327701/

Abstract

BACKGROUND

Periprosthetic joint infections (PJIs) following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are associated with substantial morbidity. A better understanding of the costs of PJI treatment can inform prevention, treatment, and reimbursement strategies. The purpose of the present study was to describe direct inpatient medical costs associated with the treatment of hip and knee PJI.

METHODS

At a single tertiary care institution, 176 hips and 266 knees that underwent 2-stage revisions for the treatment of PJI from 2009 to 2015 were compared with 1,611 hips and 1,276 knees that underwent revisions for aseptic indications. In addition, 84 hips and 137 knees that underwent irrigation and debridement (I&D) with partial component exchange were compared with 39 hips and 138 knees that underwent partial component exchange for aseptic indications. Line-item details of services billed during hospitalization were retrieved, and standardized direct medical costs were calculated in 2018 inflation-adjusted dollars.

RESULTS

The mean direct medical cost of 2-stage revision THA performed for the treatment of PJI was significantly higher than that of aseptic revision THA ($58,369 compared with $22,846, p < 0.001). Similarly, the cost of 2-stage revision TKA performed for the treatment of PJI was significantly higher than that of aseptic revision TKA ($56,900 compared with $24,630, p < 0.001). Even when the total costs of aseptic revisions were doubled for a representative comparison with 2-stage procedures, the costs of PJI procedures were 15% to 28% higher than those of the doubled costs of aseptic revisions (p < 0.001). The mean direct medical cost of I&D procedures for PJI was about twofold higher than of partial component exchange for aseptic indications.

CONCLUSIONS

The direct medical costs of operative treatment of PJI following THA and TKA are twofold higher than the costs of similar aseptic revisions. The high economic burden of PJI warrants efforts to reduce the incidence of PJI. Reimbursement schemes should account for the high costs of treating PJI in order to ensure sustainable patient care.

LEVEL OF EVIDENCE

Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

全髋关节置换术（THA）和全膝关节置换术（TKA）后发生的假体周围关节感染（PJI）会导致严重的发病率。更好地了解 PJI 治疗的成本可以为预防、治疗和报销策略提供信息。本研究的目的是描述与髋关节和膝关节 PJI 治疗相关的直接住院医疗费用。

方法

在一家三级医疗机构中，比较了 2009 年至 2015 年期间因 PJI 进行 2 期翻修的 176 髋和 266 膝与因无菌性原因进行翻修的 1,611 髋和 1,276 膝。此外，比较了接受灌洗和清创术（I&D）联合部分假体置换的 84 髋和 137 膝与因无菌性原因接受部分假体置换的 39 髋和 138 膝。检索了住院期间服务计费的明细，并以 2018 年通胀调整后的美元计算了标准化的直接医疗费用。

结果

PJI 治疗的 2 期翻修 THA 的平均直接医疗费用明显高于无菌性翻修 THA（58,369 美元比 22,846 美元，p < 0.001）。同样，PJI 治疗的 2 期翻修 TKA 的费用也明显高于无菌性翻修 TKA（56,900 美元比 24,630 美元，p < 0.001）。即使将无菌性翻修的总费用增加一倍以代表与 2 期手术进行比较，PJI 手术的费用仍比无菌性翻修增加费用的 15%至 28%（p < 0.001）。I&D 手术用于 PJI 的直接医疗费用平均是用于无菌性适应证的部分假体置换的两倍。