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Background: Complex surgical site infections (SSIs) and revisions for these infectious complications following total knee and hip arthroplasties are associated with significant economic costs., Aim: To evaluate the cost of one-stage and two-stage revision; debridement, antibiotics and implant retention (DAIR); and DAIR with liner exchange for complex hip or knee SSIs in Alberta, Canada., Methods: The Alberta Health Services Infection Prevention and Control database was used to identify individuals aged ≥18 years from the two major urban centres in Alberta - Calgary and Edmonton - with complex hip or knee SSIs who underwent surgical intervention between 1 st April 2012 and 31 st March 2019. Micro-costing and gross costing methods were used to estimate 12- and 24-month costs following the initial hospital admission for arthroplasty. Subgroup, inverse Gaussian and gamma regression analyses were used to evaluate associations between cost and revision procedure, age, sex and comorbidities., Findings: In total, 382 patients with complex SSIs were identified, with a mean age of 66.1 years. DAIR and DAIR with liner exchange resulted in the lowest 12- and 24-month costs at $53,197 [95% confidence interval (CI) $38,006-68,388] and $57,340 (95% CI $48,576-66,105), respectively; two-stage revision was the costliest procedure. Most of the costs incurred (>98%) were accrued within the first 12 months following the initial procedure., Conclusions: Medical costs are highest in the 12 months following initial arthroplasty, and for two-stage revision procedures in hip and knee complex SSIs., (Copyright © 2022 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Background: Surgical site infection (SSI) following hip or knee arthroplasty poses a serious health and economic burden., Aim: To evaluate SSI management strategies and outcomes to help address this problem., Methods: A retrospective cohort study was undertaken of adults undergoing primary total hip or knee arthroplasty who were identified to have a complex SSI by infection prevention and control surveillance audit. Audits identified SSI within 90 days of arthroplasty. Patients at two tertiary referral centres in Edmonton, Alberta, Canada from 2012 to 2019 were included, and SSI cases were followed for 2 years., Findings: In total, 240 SSIs were identified. Of these, 202 (84%) cases were managed with debridement with antibiotics and implant retention (DAIR), of which 71% achieved cure. The use of any topical intra-operative antibiotic in DAIR was not associated with improved outcome (odds ratio 1.68, 95% confidence interval 0.91-3.10; P=0.097). DAIR performed 31-90 days after arthroplasty had a lower chance of cure compared with DAIR performed within 30 days of arthroplasty; however, this difference was not significant (60 vs 73%; P=0.123). Initial treatment failures requiring additional surgery had a 51% cure rate. The majority (78%) of treatment failures initially managed with DAIR ultimately required two-stage revision., Conclusions: This study provides insight from a population-based perspective into the surgical management of SSI after primary total hip or knee arthroplasty in a large cohort. Additionally, SSIs that had initial management failure were followed. These data can inform future studies, such as the economic burden associated with these infections, and may be used to plan interventions to optimize SSI management., (Copyright © 2022 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Objective: To evaluate the cost of 1-stage and 2-stage revisions, debridement, antibiotic and implant retention (DAIR) and DAIR with liner exchange for complex surgical site infections (SSIs) following hip and knee replacements., Design: Retrospective population-based economic analysis of patients undergoing intervention for SSIs between April 1, 2012 and March 31, 2019., Setting: The study was conducted in the Calgary zone of Alberta Health Services (AHS) in Canada., Participants: Individuals >18 years with complex SSI following hip or knee replacement., Methods: Patients with complex SSIs were identified using the AHS infection prevention and control database. A combination of microcosting and gross costing methods were used to estimate 12- and 24-month costs following the initial hospital admission for arthroplasty. Subgroup, inverse Gaussian and γ regression analyses were used to evaluate the impact of age and comorbidities on cost., Results: In total, 142 patients with complex SSIs were identified, with a mean age of 66.8 years. Total direct medical costs in United States dollars of 2-stage revisions were ($100,992 (95% CI, 34,587-167,396) at 12 months. The 1-stage revision ($41,176; 95% CI, 23,361-58,991), DAIR with liner exchange ($41,267; 95% CI, 29,923-52,612) and DAIR ($46,605; 95% CI, 15,277-76,844) were associated with fewer costs at 12 months. Age >65 years and chronic complications of diabetes and hypertension were associated with increased costs in subgroup and regression analysis., Conclusions: Medical costs are highest at 12 months and for 2-stage revisions in hip and knee complex SSI cases. Further work should explore surgical outcomes correlated with costs to enhance patient care.

Background: Use of vascular and cardiac devices has expanded and is associated with a relative, though disproportionate, increase in device-associated infections., Aim: To describe the association between cardiac/vascular device infections and outcomes in those with, and without systemic infections., Methods: We used the 2016 National Inpatient Sample and the International Classification of Diseases - 10 th revision codes to identify hospitalized individuals with vascular and cardiac device infections. Linear and logistic regression models were utilized to compare outcomes of death, length of stay (LOS) and hospitalization costs between individuals with and without systemic infection., Findings: There were a total of 65,110 hospitalizations associated with device infections with a mean age of 61.3 ± 15.9 years (standard deviation); 28,650 (44%) had systemic infections. Elixhauser comorbidity scores of three or greater were observed in 91.2% of individuals with systemic infections along with a higher prevalence of diabetes, renal disease and heart failure. The primary outcome of mortality was observed in 3965 individuals with an odds ratio of 3.97 (95% confidence interval (CI), 2.92-3.95) in those with systemic infections compared with those without. Mean LOS was 3.44 days longer (95% CI, 2.92-3.95) and mean cost was US$11,776 greater (95% CI, US$9826-12,727) in the systemic infection cohort., Conclusion: Systemic cardiac and vascular device infections were associated with increased mortality, LOS and costs. Considering the increasing use of these life-saving devices, further work is needed to identify those at risk for infectious complications, particularly systemic infection, in order to enhance preventative strategies and improve health outcomes., (Copyright © 2020 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)