526. The Impact of Periprosthetic Infections Following Total Knee Arthroplasty at a Specialized Tertiary-Care Center
Session: Poster Abstract Session: Surgical Site Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: Surgical site infections are a potentially devastating post-operative complication following total knee arthroplasty (TKA). These infections represent an increased risk of morbidity and mortality for the patient, as well as an increased economic burden for the entire healthcare system. The purpose of this study was to measure the impact of periprosthetic joint infections on the length of hospitalization, readmissions, and other associated costs.

Methods: Between 2007 and 2011, medical records and an infection tracking database were reviewed at a specialized tertiary-care center to identify periprosthetic infections occurring following primary TKAs, which eventually required a two-stage revision. We identified 21 consecutive patients who had infections and matched them to a group of 21 non-infected patients undergoing primary TKA. Actual costs were obtained by reviewing hospital financial records. These costs included charges for hospital bed per day, pharmaceutical services, medical and surgical supplies, laboratory costs, diagnostic and radiographic evaluations, anesthesia services, consults, physical therapy and clinic visits.

Results: Of the patients with periprosthetic infections, the mean length of hospitalization per visit was 5.3 days (range, 2 to 27 days) compared to 3.0 days (range, 2 to 6 days) for the matched group. The mean number of readmissions for the study group was 3.6 (range, 1 to 7) compared to 0.1 (range, 0 to 2) in the matched group within one year after primary TKA. The mean number of clinic visits for the study group was 6.5 times (range, 2 to 12 times) compared to 1.3 times (range, 1 to 2 times) The mean annual cost per patient with an infection was $116,383 (range, $44,416 to $269,914) compared to a mean of $28,249 (range, $20,454 to $47,957) in the matched group.

Conclusion: Periprosthetic infections following TKA increased the readmission rate by nearly 25-fold, increased the mean hospitalization period by two-fold, increased the mean number of clinic visits by 5-fold and increased the annual cost per patient by approximately 5-fold.  This represents a tremendous economic burden for healthcare centers and to the patients. This warrants further studies to evaluate better infection prevention methodologies for lower extremity total joint arthroplasty procedures.

Bhaveen H. Kapadia, MD, Kimona Issa, MD and Michael A. Mont, MD, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD

Disclosures:

B. H. Kapadia, Sage Products, Inc.: Consultant and Speaker's Bureau, Speaker honorarium

K. Issa, None

M. A. Mont, Stryker: Consultant, Consulting fee, Licensing agreement or royalty and Research support
Wright Medical Technology, Inc.: Consultant, Consulting fee, Licensing agreement or royalty and Research support
Biocomposites: Consultant, Consulting fee
DJ Orthopaedics: Consultant, Consulting fee and Research support
Janssen: Consultant, Consulting fee
Joint Active Systems: Consultant, Consulting fee and Research support
Medtronic: Consultant, Consulting fee
Sage Products, Inc.: Consultant, Consulting fee and Research support
TissueGene: Consultant, Consulting fee
National Institutes of Health (NIAMS & NICHD): Research, Research support
AAOS: Board Member, N/A

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