The economic impact of periprosthetic infection in total hip arthroplasty

Background: Periprosthetic joint infection (PJI) is the third leading cause of total hip arthroplasty (THA) failure. Although controversial, 2-stage revision remains the gold standard treatment for PJI in most situations. To date, there have been few studies describing the economic impact of PJI in today's health care environment. The purpose of the current study was to obtain an accurate estimate of the institutional cost associated with the management of PJI in THA and to assess the economic burden of PJI compared with primary uncomplicated THA. Methods: We conducted a review of primary THA cases and 2-stage revision THA for PJI at our institution. Patients were matched for age and body mass index. All costs associated with each procedure were recorded. Descriptive statistics were used to summarize the collected data. Mean costs, length of stay, clinic visits and readmission rates associated with the 2 cohorts were compared. Results: Fifty consecutive cases of revision THA were matched with 50 cases of uncomplicated primary THA between 2006 and 2014. Compared with the primary THA cohort, PJI was associated with a significant increase in mean length of hospital stay (26.5 v. 2.0 d, p < 0.001), mean number of clinic visits (9.2 v. 3.8, p < 0.001), number of readmissions (12 v. 1, p < 0.001) and average overall cost (Can$38 107 v. Can$6764, t = 8.3, p < 0.001). Conclusion: Treatment of PJI is a tremendous economic burden. Our data suggest a 5-fold increase in hospital expenditure in the management of PJI compared with primary uncomplicated THA. Contexte : L'infection articulaire periprothetique (IAP) arrive au troisieme rang des principales causes d'echec de l'arthroplastie (ou prothese) totale de la hanche (PTH). Meme si elle est controversee, la revision en 2 etapes demeure le traitement standard pour l'IAP dans la plupart des cas. A ce jour, peu d'etudes ont decrit l'impact economique de l'IAP dans l'environnement actuel des soins de sante. Le but de la presente etude etait d'obtenir une estimation precise des couts institutionnels associes a la prise en charge de l'IAP dans la PTH et d'evaluer le fardeau economique de l'IAP comparativement a une PTH primaire non compliquee. Methodes : Nous avons passe en revue les cas de PTH primaire et de revision de PTH en 2 etapes pour cause d'IAP dans notre etablissement. Les patients ont ete assortis selon l'age et l'indice de masse corporelle. Tous les couts associes a chaque intervention ont ete consignes. Des statistiques descriptives ont servi a resumer les donnees recueillies. Nous avons compare les couts moyens, la duree des sejours, les visites a la clinique et les taux de readmission associes aux 2 cohortes. Resultats : Cinquante cas consecutifs de revision de PTH ont ete assortis a 50 cas de PTH primaire non compliquee entre 2006 et 2014. Comparativement a la cohorte de PTH primaire, les cas d'IAP ont ete associes a une augmentation significative de la duree moyenne du sejour hospitalier (26,5 j c. 2,0 j, p < 0,001), du nombre moyen de visites a la clinique (9,2 c. 3,8, p < 0,001), du nombre des readmissions (12 c. 1, p < 0,001) et du cout global moyen (38 107 $ CA c. 6764 $ CA, t = 8,3, p < 0,001). Conclusion : Le traitement de l'IAP represente un enorme fardeau economique. Selon nos donnees, les depenses hospitalieres associees a sa prise en charge sont 5 fois plus grandes que pour la PTH primaire non compliquee.
Deep infection is a devastating complication in total hip arthroplasty (THA) resulting in significant patient and institutional burden. Current literature suggests that the incidence of periprosthetic joint infection (PJI) is [...]