September 15, 2018
2 min read

Costs quadruple when SSIs develop after hip, knee replacements

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The total 1-year health care cost for patients who develop complex surgical site infections, or SSIs, following hip and knee replacements is more than four times higher compared with patients who do not sustain an infection, according to study results published in Infection Control & Hospital Epidemiology.

The results are from a database of Canadian patients, but the researchers also estimated the cost to manage SSIs in hip and knee arthroplasty patients in the United States.

“Nearly 800,000 primary hip and knee arthroplasty procedures are performed annually in North America,” Elissa D. Rennert-May, MD, from the departments of medicine and community health sciences at the University of Calgary, and colleagues wrote. “Approximately 1% of these are complicated by a complex surgical site infection, leading to very high health care costs. However, population-based studies to properly estimate the economic burden are lacking. We aimed to address this knowledge gap.”

Rennert-May and colleagues used the Alberta Bone and Joint Health Institute databases to create a cohort of patients in Alberta, Canada, who received a primary hip or knee arthroplasty between April 1, 2012, and March 31, 2015. They collected data on joint infections in adults aged 18 years or older from the Alberta Health Services infection prevention and control group. The study included data for all complex SSIs found within 90 days of arthroplasty from April 2012 to March 2015.

They calculated that the 12-month cumulative health care costs for patients who developed a complex SSI were $95,321 vs. $19,893 for those who did not, equaling $68,150 and $14,223 in U.S. dollars respectively.

“Using the average 1-year total health care costs, in Alberta we spend approximately $8.3 million annually on patients who develop complex SSI following primary hip and knee arthroplasties compared to the $1.67 million we would spend had those patients not developed a complex SSI,” the authors concluded.

Applying the same complex infection rate to the United States, where there are 700,000 hip and knee arthroplasties annually — and where related SSIs are expected to increase in an aging population, according to a recently published study — Rennert-May and colleagues determined that the annual expenditure would be approximately $496 million in U.S. dollars to manage SSIs in this patient population, compared with $104 million had no infection developed.

“In conclusion, we estimated the incremental cost of managing patients with complex SSI following primary hip or knee arthroplasty, noting a difference in total mean 1-year costs of more than $75,000 (U.S. $53,621),” the authors wrote. “Future research should consider the cost-effectiveness of different methods to prevent complex SSI following arthroplasty. Infectious diseases physicians should be encouraged to work with orthopedic surgeons and hospital administrators to promote the implementation of cost-effective strategies to prevent SSI.” – by Caitlyn Stulpin

Disclosures: The authors report no relevant financial disclosures.