Abstract
Background: There is a constant increase of joint arthroplasties performed, with an infectious risk of 1-2%. Different therapeutic options for prosthetic-joint infections exist, but surgery remains essential. With a two-stage exchange procedure, a success rate above 90% can be expected. Currently, there is no consensus regarding the optimal interval duration between explantation and reimplantation. This retrospective study aimed to assess the economic impact of a two-stage exchange from a single-hospital perspective.Methods: 21 patients who have undergone a two-stage exchange of a hip or knee prosthetic-joint infection at the University Hospital of Lausanne (Switzerland) from 2012 to 2013 were included. The revenues earned according to the Swiss Diagnosis Related Groups (SwissDRG) system introduced in 2012 and the costs were compared for each hospital stay.Results: The remuneration ranged from 26'806 to 42'978 Swiss francs (CHF) (~ 22'905-36'723 EUR, median 36'338 CHF, ~ 31'049 EUR). The median total cost per patient was 76'000 CHF (~ 65'000 EUR) (51'151 to 118'263; hip median 79'744, knee median 66'708). The main determinant of the costs was the length of the hospital stay. Revenues never covered all the costs, even with a short-interval procedure. The hospital lost a median of 35'000 CHF per patient (~ 30'000 EUR) (22'280 to 64'666).Conclusion: The current DRG system may not be specific enough for rewarding prosthetic-joint infections. Several options could be considered to act on the length of the hospital stay. In order to cover costs in complicated cases, such as prosthetic-joint infections, more specific DRGs are needed.
Highlights
In Switzerland, more than 35’000 joint arthroplasty procedures are performed every year to improve the quality of life of an aging population.[1]
Patients The inclusion criteria were to have a two-stage exchange from January 2012 to December 2013, with a single stay at the University Hospital of Lausanne (CHUV) and a SDRG expected for a prosthetic-joint infection [Table 1]
37 prosthetic-joint infections were treated with a two-stage exchange in the Department of Septic Surgery at the University Hospital of Lausanne from 2012 to 2013
Summary
In Switzerland, more than 35’000 joint arthroplasty procedures are performed every year to improve the quality of life of an aging population.[1] Prosthetic-joint infections (PJI) are rare, with an incidence of 1-2%, but they represent serious complications in terms of morbidity and costs.[2] For adequate care of a patient, the surgeon has to choose between different therapeutic options, of which surgery remains essential. There is no consensus regarding the optimal interval duration between the prosthesis explantation and reimplantation procedure. There is no consensus regarding the optimal interval duration between explantation and reimplantation. This retrospective study aimed to assess the economic impact of a two-stage exchange from a single-hospital perspective
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