Abstract
Purpose: to quantify the cost of hospitalisation and theatre time in the treatment of infected primary total knee replacements.
Materials and Methods: hospital approval was obtained for the study. Inclusion criteria were defined as: patients requiring surgery for deep or superficial infection of a primary total knee replacement (TKR) with subsequent positive bacteriological cultures. Clinical coding provided a list of patients with the ICD 10 code T845 (infection or inflammatory reaction due to an internal joint replacement) over a 2 year period and notes of patients were obtained to confirm the inclusion criteria were met. The theatre procedures performed and numbers of days in hospital for all admissions related to joint infection were recorded. The cost of a day in hospital and the cost of each procedure by time in minutes were obtained from the hospital finance department hence the overall cost of hospitalisation and theatre per patient estimated.
Results: 15 patients were identified as having undergone surgery for an infected primary TKR. Prolonged hospital stay, predominantly for administration of antibiotics claimed the largest proportion of expenditure in our patient group. An average of 64 excess days per patient were spent in hospital (range 13 to 218). The cost of an overnight hospital stay is £180, therefore the cost per patient was £11544. Seven day procedures at a cost of £473 each were also carried out. Each patient underwent an average of 4.7 theatre procedures (range 1 to 12). The most common surgical procedures were joint washout / debridement for early infection, joint aspiration, first and second stage revision. The cost of a minute of theatre time is £12.97, hence the cost of theatre time per patient was £4959. The overall estimated cost per patient for treatment of an infected primary total knee replacement is £16503 (exclusive of implant and antibiotic costs).
Conclusion: the cost of an infected TKR is a substantial financial burden for trusts as well as a catastrophic complication for patients. Methods of reducing expenditure include reduction in hospital stay by administration of antibiotics by district nurses or trained family members, rapid management of early joint infection by washout and debridement with the possibility of avoiding revision surgery and explantation of components upon diagnosis of bone/cement interface infection hence avoiding futile operations.
Correspondence should be addressed to Mr Tim Wilton, BASK at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
