Villa Jesus M, Pannu Tejbir S, Eysler Robert B, Singh Vivek, Klika Alison K, Higuera Carlos A
Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
Arthroplast Today. 2025 Jan 8;31:101609. doi: 10.1016/j.artd.2024.101609. eCollection 2025 Feb.
For reimbursement purposes, current coding fails to reflect the true complexity and resource utilization of hospital encounters for surgeries performed to treat periprosthetic total hip arthroplasty (THA) infection. Therefore, when compared to aseptic revisions, we sought to determine (1) Is length of stay (LOS) longer for septic surgeries? (2) Are septic procedures more expensive? and (3) How do different surgical procedures for infection compare with aseptic revisions on hospital LOS and charges?
Retrospective chart review of 596 unilateral THA reoperations (473 patients) performed at a single institution (January 2015 to November 2020). Demographics, professional (ie, physicians), and technical (ie, room, implants) hospital charges per case were compared between 6 different surgery types: (1) aseptic revision (control; n = 364); (2) debridement, antibiotics, and implant retention (n = 11); (3) explantation (n = 145); (4) spacer exchange (n = 7); (5) 2-stage reimplantation (n = 59); and (6) 1-stage reimplantation (n = 10).
Overall, septic surgeries (n = 232) had longer LOS (mean 6.3 vs 3.3 days, < .001) and 43% higher total charges ( < .001), vs aseptic revisions. Particularly, explantations had longer LOS (7.1 vs 3.3 days) and 56% higher total charges (both < .001). When compared to aseptic revisions, proportional total charges for septic procedures were debridement, antibiotics, and implant retention +29%, = .4; explantation +56%, < .001; spacer exchange +69%, = .008; 2-stage reimplantation +11%, = .659; and 1-stage reimplantation +46%, = .06.
Some surgical procedures performed to treat periprosthetic THA infection are associated with longer LOS and significantly higher hospital charges when compared to aseptic revisions. Reimbursement adjustment is needed as current coding for septic reoperations does not reflect actual hospital resource consumption and this situation may limit access to patient care.
出于报销目的，当前的编码未能反映治疗人工关节周围全髋关节置换术（THA）感染的手术住院治疗的真正复杂性和资源利用情况。因此，与无菌翻修手术相比，我们试图确定：（1）感染性手术的住院时间（LOS）是否更长？（2）感染性手术费用是否更高？以及（3）针对感染的不同手术程序与无菌翻修手术相比，在住院时间和费用方面情况如何？
对在单一机构（2015年1月至2020年11月）进行的596例单侧THA再次手术（473例患者）进行回顾性病历审查。比较了6种不同手术类型的每例患者的人口统计学、专业（即医生）和技术（即手术室、植入物）医院费用：（1）无菌翻修（对照组；n = 364）；（2）清创、抗生素和植入物保留（n = 11）；（3）取出术（n = 145）；（4）间隔物更换（n = 7）；（5）两阶段再植入（n = 59）；以及（6）一阶段再植入（n = 10）。
总体而言，与无菌翻修手术相比，感染性手术（n = 232）的住院时间更长（平均6.3天对3.3天，P <.001），总费用高出43%（P <.001）。特别是，取出术的住院时间更长（7.1天对3.3天），总费用高出56%（两者P <.001）。与无菌翻修手术相比，感染性手术的比例总费用为：清创、抗生素和植入物保留 +29%，P =.4；取出术 +56%，P <.001；间隔物更换 +69%，P =.008；两阶段再植入 +11%，P =.659；以及一阶段再植入 +46%，P =.06。
与无菌翻修手术相比，一些用于治疗人工关节周围THA感染的手术程序与更长的住院时间和显著更高的医院费用相关。由于目前感染性再次手术的编码不能反映实际的医院资源消耗，需要进行报销调整，这种情况可能会限制患者获得医疗护理的机会。
