Abstract
Background
Total hip arthroplasty (THA) has become one of the most commonly performed elective procedures. Today, there are nearly 50 000 annual hospitalizations for hip replacement surgery in Canada. This number is projected to increase significantly with the aging population. Periprosthetic joint infection (PJI) is the 3rd leading cause of failure following THA and is reported to occur at an incidence of 1–3%. A two-stage revision THA is the current gold standard treatment and this has a tremendous economic impact on the healthcare system. The purpose of this study is to create an accurate cost estimate of two-stage revision THA and, in turn, evaluate the economic burden of PJI as it compares to primary THA in a Canadian healthcare context.
Methods
We conducted a retrospective review of primary THA cases and two-stage revision THA for PJI at our institution. Patients were matched for age and BMI. We recorded all costs associated with each procedure, including: OR time, equipment, length of hospital stay, readmission rates, and any other inpatient resource use. Unit costs were obtained using administrative data from the case costing department at London Health Sciences Centre. Billing fees associated with the procedure were obtained from the Ontario Schedule of Benefits. Descriptive statistics were used to summarize the demographic characteristics of patients, hospital costs and resource use data. Patients with PJI were compared to the matched cohort of primary THA using the t-test (for continuous variables), and the chi-square test (for categorical variables).
Results
Fifty consecutive cases of revision THA were matched to 50 patients who underwent uncomplicated primary THA between 2006 and 2014. Periprosthetic infection was associated with a significant increase in hospital stay (26.5 vs. 2.0; t=4.95, p<0.001), clinic visits (9.5 vs. 3.8; T= 6.49, p<0.001), readmission rates (12 vs. 1; X2 11.1, p<0.001) and overall cost ($39 953 vs. $7 460; T=73, p<0.001) in comparison to the primary arthroplasty cohort.
Conclusion
Two-stage revision for infected THA is a significant economic burden to the healthcare system. Our data suggests a 5-fold increase in healthcare cost when compared to primary THA. This may be an important consideration when distributing resources among Canadian tertiary care centres.
