Antonios Joseph K, Bozic Kevin J, Clarke Henry D, Spangehl Mark J, Bingham Joshua S, Schwartz Adam J
Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, AZ, USA.
Department of Orthopaedic Surgery, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
Arthroplast Today. 2021 Oct 5;11:187-195. doi: 10.1016/j.artd.2021.08.009. eCollection 2021 Oct.
Periprosthetic joint infection (PJI) is a common cause of revision total knee surgery. Although debridement and implant retention (DAIR) has lower success rates in the chronic setting, it is an accepted treatment of acute PJI, whether postoperatively or with late hematogenous seeding. There are two broad DAIR strategies: single debridement and planned double debridement. The purpose of this study is to evaluate the cost-effectiveness of single vs double DAIR for acute PJI in total knee arthroplasty.
A decision tree using single or double DAIR as the treatment strategy for acute PJI was constructed. Quality-adjusted life years and costs associated with the two treatment arms were calculated. Treatment success rates, failure rates, and mortality rates were derived from the literature. Medical costs were derived from both the literature and Medicare data. A cost-effectiveness plane was constructed from multiple Monte Carlo trials. A sensitivity analysis identified parameters most influencing the optimal strategy decision.
Double DAIR was the optimal treatment strategy both in terms of the health utility state (82% of trials) and medical cost (97% of trials). Strategy tables demonstrated that as long as the success rate of double debridement is 10% or greater than the success rate of a single debridement, the two-stage protocol is cost-effective.
A double DAIR protocol is more cost-effective than single DAIR from a societal perspective.
人工关节周围感染（PJI）是全膝关节翻修手术的常见原因。尽管清创并保留植入物（DAIR）在慢性感染情况下成功率较低，但它是急性PJI的一种公认治疗方法，无论是术后感染还是晚期血源性播散。DAIR有两种主要策略：单次清创和计划性二次清创。本研究的目的是评估全膝关节置换术中单次与二次DAIR治疗急性PJI的成本效益。
构建以单次或二次DAIR作为急性PJI治疗策略的决策树。计算两个治疗组的质量调整生命年和相关成本。治疗成功率、失败率和死亡率来自文献。医疗成本来自文献和医疗保险数据。通过多次蒙特卡洛试验构建成本效益平面。敏感性分析确定了对最佳策略决策影响最大的参数。
从健康效用状态（82%的试验）和医疗成本（97%的试验）来看，二次DAIR都是最佳治疗策略。策略表显示，只要二次清创的成功率比单次清创的成功率高10%或更多，两阶段方案就是具有成本效益的。
从社会角度看，二次DAIR方案比单次DAIR更具成本效益。
