-
Tytuł:
-
The Economics of Antibiotic Cement in Total Knee Arthroplasty: Added Cost with No Reduction in Infection Rates.
-
Autorzy:
-
Yayac M; Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
Rondon AJ; Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
Tan TL; Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
Levy H; Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
Parvizi J; Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
Courtney PM; Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
-
Źródło:
-
The Journal of arthroplasty [J Arthroplasty] 2019 Sep; Vol. 34 (9), pp. 2096-2101. Date of Electronic Publication: 2019 Apr 26.
-
Typ publikacji:
-
Journal Article
-
Język:
-
English
-
Imprint Name(s):
-
Publication: New Brunswick, NJ : Taylor and Francis
Original Publication: [New York, NY : Churchill Livingstone, c1986-
-
MeSH Terms:
-
Anti-Bacterial Agents/*economics
Arthritis, Infectious/*prevention & control
Arthroplasty, Replacement, Knee/*adverse effects
Arthroplasty, Replacement, Knee/*economics
Bone Cements/*economics
Prosthesis-Related Infections/*prevention & control
Aged ; Anti-Bacterial Agents/therapeutic use ; Arthritis, Infectious/economics ; Cost-Benefit Analysis ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Multivariate Analysis ; Patient Readmission ; Prosthesis-Related Infections/economics ; Retrospective Studies ; Treatment Outcome
-
Contributed Indexing:
-
Keywords: antibiotic-laden bone cement; cost analysis; periprosthetic joint infection; primary total knee arthroplasty; risk mitigation
-
Substance Nomenclature:
-
0 (Anti-Bacterial Agents)
0 (Bone Cements)
-
Entry Date(s):
-
Date Created: 20190525 Date Completed: 20200805 Latest Revision: 20200805
-
Update Code:
-
20240104
-
DOI:
-
10.1016/j.arth.2019.04.043
-
PMID:
-
31122848
-
Background: To reduce the substantial clinical and financial burden of periprosthetic joint infection (PJI), some surgeons advocate for the use of antibiotic-loaded bone cement (ALBC) in primary total knee arthroplasty (TKA), although its effectiveness continues to be debated in the literature. The purpose of this study was to determine whether the routine use of ALBC is cost-effective in reducing PJI after primary TKA.
Methods: We retrospectively reviewed a consecutive series of patients undergoing cemented primary TKA at two hospitals within our institution from 2015 to 2017. We compared demographics, comorbidities, costs, and PJI rates between patients receiving ALBC and plain cement. We performed a multivariate regression analysis to determine the independent effect of ALBC on PJI rate. We calculated readmission costs for PJI and reduction in PJI needed to justify the added cost of ALBC.
Results: Of 2511 patients, 1077 underwent TKA with ALBC (43%), with no difference in PJI rates (0.56% vs 0.14%, P = .0662) or complications (1.2% vs 1.6%, P = .3968) but higher cement costs ($416 vs $117, P < .0001) and overall procedure costs ($6445 vs $5.968, P < .0001). ALBC had no effect on infection rate (P = .0894). Patients readmitted with PJI had higher overall 90-day episode-of-care claims costs ($49,341 vs $19,032, P < .001). To justify additional costs, ALBC would need to prevent infection in one of every 101 patients.
Conclusion: Routine use of ALBC in primary TKA is not cost-effective, adding $299 to the cost of episode of care without a reduction in PJI rate. Further study is needed to determine whether select use of ALBC would be justified in high-risk patients.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
