Abstract
Introduction
Periprosthetic joint infection (PJI) is a significant challenge to the orthopedic surgeon, patient, hospital, and insurance provider. As the number of total hip and knee replacements has increased, the number of revision procedures has also increased. Revisions for infection require a greater amount of hospital and surgeon resources than noninfectious revisions. Our study compares the financial information for all two-stage revision surgeries performed at our tertiary referral center for hip or knee PJI over the last four years, separating them into two groups: referral versus self-originating cases.
Methods
We performed a review of all patients who underwent two-stage revision hip or knee arthroplasty for infection between 2008 and 2013 at our facility. We collected detailed financial information for patients and separated them into referral versus self-originating cases, indicating whether index surgery was performed at an outside facility or at our facility, respectively. Only those patients who underwent full two-stage procedure at our facility were included.
Results
We found an increasing number of referrals over the study period. There was a non-statistical increased cost of treating hips over knees (p=0.24). We found a continued financial incentive, with no statistical difference between referral and self-originating groups, in treating hip (p=0.89) and knee (p=0.84) PJIs (Figure 1). Despite no difference in payer status, there was a non-statistical trend for a much lower reimbursement (p=0.15) in the referral hip group. We found that referral knee PJIs overall reimbursement (p=0.65), and in turn revenue (p=0.55), was non-statistically higher than that of self-originating knee PJIs. There is a significant financial disincentive in treating hip PJI referrals if the antibiotic spacer has already been placed (p=0.036) (Figure 2). We found a non-significant decreased reimbursement for treating referral knee PJIs if the antibiotic spacer has been placed prior to referral (p=0.81).
Conclusion
To our knowledge, our study is the first to extensively compare the financial implications of treating an institution's own PJIs of the knee and hip versus treating referred infections. In the modern era of referral centers accepting more of the burden of PJIs, we show there is continued financial incentive to treating one's own PJIs and referral PJIs, given the antibiotic spacer was not placed at an outside facility.
