Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-23T23:27:10.663Z Has data issue: false hasContentIssue false
  • English
  • Français

The cost of managing complex surgical site infections following primary hip and knee arthroplasty: A population-based cohort study in Alberta, Canada

Published online by Cambridge University Press:  10 September 2018

Elissa D. Rennert-May ,
John Conly ,
Stephanie Smith ,
Shannon Puloski ,
Elizabeth Henderson ,
Flora Au  and
Braden Manns
Elissa D. Rennert-May
Affiliation:
Department of Medicine, University of Calgary, Calgary, Canada Department of Community Health Sciences, University of Calgary, Calgary, Canada
John Conly
Affiliation:
Department of Medicine, University of Calgary, Calgary, Canada Department of Immunology, Microbiology and Infectious Diseases, University of Calgary, Calgary, Canada Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada O’Brien Institute for Public Health, University of Calgary, Calgary, Canada Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Canada
Stephanie Smith
Affiliation:
Department of Medicine, University of Alberta, Edmonton, Canada
Shannon Puloski
Affiliation:
Department of Surgery, University of Calgary, Calgary, Canada
Elizabeth Henderson
Affiliation:
Department of Community Health Sciences, University of Calgary, Calgary, Canada
Flora Au
Affiliation:
Department of Medicine, University of Calgary, Calgary, Canada
Braden Manns*
Affiliation:
Department of Medicine, University of Calgary, Calgary, Canada Department of Community Health Sciences, University of Calgary, Calgary, Canada O’Brien Institute for Public Health, University of Calgary, Calgary, Canada Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
*
Author for correspondence: Braden Manns; HRIC Building, 2500 University Drive NW, Calgary, AB T2N1N4. E-mail: braden.manns@ahs.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Nearly 800,000 primary hip and knee arthroplasty procedures are performed annually in North America. Approximately 1% of these are complicated by a complex surgical site infection (SSI), leading to very high healthcare costs. However, population-based studies to properly estimate the economic burden are lacking. We aimed to address this knowledge gap.

Design

Economic burden study.

Methods

Using administrative health and clinical databases, we created a cohort of all patients in Alberta, Canada, who received a primary hip or knee arthroplasty between April 1, 2012, and March 31, 2015. All patients who developed a complex SSI postoperatively were identified through a provincial infection prevention and control database. A combination of corporate microcosting data and gross costing methods were used to determine total mean 12- and 24-month costs, enabling comparison of costs between the infected and noninfected patients.

Results

Mean 12-month total costs were significantly greater in patients who developed a complex SSI compared to those who did not (CAD$95,321 [US$68,150] vs CAD$19,893 [US$14,223]; P < .001). The magnitude of the cost difference persisted even after controlling for underlying patient factors. The most commonly identified causative pathogen (38%) was Staphylococcus aureus (95% MSSA).

Conclusions

Complex SSIs following hip and knee arthroplasty lead to high healthcare costs, which are expected to rise as the yearly number of surgeries increases. Using our costing estimates, the cost-effectiveness of different strategies to prevent SSIs should be investigated.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 10 , October 2018 , pp. 1183 - 1188
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Hip and knee replacements in Canada: Canadian joint replacement registry 2014 annual report. Canadian Institute for Health Information website. https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC2625. Published 2014. Accessed March 15, 2018.Google Scholar
2. Rennert-May, E, Bush, K, Vickers, D, Smith, S. Use of a provincial surveillance system to characterize postoperative surgical site infections after primary hip and knee arthroplasty in Alberta, Canada. Am J Infect Control 2016;44:1310–1314.Google Scholar
3. Total hip and total knee replacement. The Joint Commission website. https://www.jointcommission.org/total_hip__total_knee_replacement_/. Published 2017 Accessed April 2, 2018.Google Scholar
4. Hospitalizations, early revisions and infections following joint replacement surgery. Canadian Institute for Health Information website. https://secure.cihi.ca/free_products/joint_complications_aib_e.pdf. Published 2008. Accessed March 15, 2018.Google Scholar
5. Miletic, KG, Taylor, TN, Martin, ET, Vaidya, R, Kaye, KS. Readmissions after diagnosis of surgical site infection following knee and hip arthroplasty. Infect Control Hosp Epidemiol 2014; 35:152–157.Google Scholar
6. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2018; 36:309–332.Google Scholar
7. Osmon, DR, Berbari, EF, Berendt, AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2013; 56:e1–e25.Google Scholar
8. Zimlichman, E, Henderson, D, Tamir, O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013; 173:2039–2046.Google Scholar
9. Tansey, R, Mirza, Y, Sukeik, M, Shaath, M, Haddad, FS. Definition of periprosthetic hip and knee joint infections and the economic burden. Open Orthop J 2016;10:662–668.Google Scholar
10. Kurtz, SM, Lau, E, Watson, H, Schmier, JK, Parvizi, J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012;27:61–65.Google Scholar
11. Kuiper, JW, Willink, RT, Moojen, DJF, van den Bekerom, MP, Colen, S. Treatment of acute periprosthetic infections with prosthesis retention: review of current concepts. World J Orthop 2014,5:667–676.Google Scholar
12. Marculescu, CE, Berbari, EF, Hanssen, AD, et al. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis 2006;42:471–478.Google Scholar
13. Fehring, TK, Odum, SM, Berend, KR, et al. Failure of irrigation and debridement for early postoperative periprosthetic infection. Clin Orthop Relat Res 2013;471:250–257.Google Scholar
14. Gehrke, T, Alijanipour, P, Parvizi, J. The management of an infected total knee arthroplasty. Bone Joint J 2015; 97B:20–29.Google Scholar
15. Lauderdale, KJ, Malone, CL, Boles, BR, Morcuende, J, Horswill, AR. Biofilm dispersal of community-associated methicillin-resistant Staphylococcus aureus on orthopedic implant material. J Orthop Res 2010; 28:55–61.Google Scholar
16. Hutzler, L, Williams, J. Decreasing the incidence of surgical site infections following joint replacement surgery. Bull Hosp Jt Dis 2013;75:268–273.Google Scholar
17. Fabbian, F, De Giorgi, A, Maietti, E, et al. A modified Elixhauser score for predicting in-hospital mortality in internal medicine admissions. Eur J Intern Med 2017;40:37–42.Google Scholar
18. Shrive, FMC, Ghali, WA, Donaldson, C, Manns, BJ. The impact of using different costing methods on the results of an economic evaluation of cardiac care: microcosting vs gross-costing approaches. Health Econ 2009; 18:377–388.Google Scholar
19. Hutcheson G. GLM models and OLS regression. Research-Training.net website. http://www.research-training.net/addedfiles/2011aManchester/Manchester2011OLS.pdf. Published 2011. Accessed March 15, 2018.Google Scholar
20. Kapadia, BH, McElroy, MJ, Issa, K, Johnson, AJ, Bozic, KJ, Mont, MA. The economic impact of periprosthetic infections following total knee arthroplasty at a specialized tertiary-care center. J Arthroplasty 2014; 29:929–932.Google Scholar
21. Kapadia, BH, Banerjee, S, Cherian, JJ, Bozic, KJ, Mont, MA. The eonomic impact of periprosthetic infections after total hip arthroplasty at a specialized tertiary-care center. J Arthroplasty 2016; 31:1422–1426.Google Scholar
22. Ramos, N, Stachel, A, Phillips, M, Vigdorchik, J, Slover, J, Bosco, JA. Prior Staphylococcus aureus nasal colonization: a risk factor for surgical site infections following decolonization. J Am Acad Orthop Surg 2016;24:880–885.Google Scholar
23. Chen, AF, Heyl, AE, Xu, PZ, Rao, N, Klatt, BA. Preoperative decolonization effective at reducing staphylococcal colonization in total joint arthroplasty patients. J Arthroplasty 2013;28:18–20.Google Scholar