Abstract
The aim of the study is to determine reimbursement cost of treating periprosthetic joint infection (PJI) in Poland, the rate of THR and TKA septisc revisions in the years 2009–2013, the type of revision, comparison of the costs of septic and aseptic revisions.
Data published on the website of the National Health Fund (NHF) were analysed on revision arthroplasty for aseptic and septic recisions in the years 2009–2013. To calculate the cost of revision NHF report for 2013 was analysed giving the average cost of the group of septic and aseptic revision.
According to NHF „point system”, in therapy of PJI three types of revisions can by choosen: partial revision (305 points), one-stage revision (490 points), and two-stage revision with spacer (728 points for two stages). In the years 2009–2013 a total of 260030 THR and TKA were performer, including 23027 revisions. There were 4221 septic revisions: 1677 hips and 1430 knees. In 2013 septic revisions stated 1.38% (556 of 40152) of all hip and 2.56% (325 of 12654) of all knee replacements. Septic revisions constituted 14.67% of all hip revisions and 30.23% of all knee revisions. The average refund of the NHF for a minor revision for PJI in 2013 was 3889 Euro and the average cost for hospital was 4127 Euro. The average refund of the NHF for a one-stege revision (for any reason) in 2013 was 6124 Euro, and the average cost for hospital was 6339 Euro. The average refund of the NHF for a two-stage revision (for two stages) in 2013 was 10013 Euro, and the average cost for hospital was 10466 Euro for two hospital stays. Data revealed that in 2013 all 921 revisions performed for PJI were reimbursed as „minor revisions” for 3889 Euro. In 2013 the difference between the average cost incurred by the hospital and the refund of the NHF for septic revision was at least 238 Euro and for the entire year undervalued refund for treatment of 921 infected prostheses was at least 219198 Euros.
The reimbursement for revision due to infection encourages surgeons to perform two-stage septic revision instead of debridement or one-step, because two-step treatment in the final bill is better paid.
