1188
Table 4. Ordinary Least Squares Regression Analysis Examining the Demographic and Clinical Factors Associated With Mean Total 1-Year Costs for Patients Undergoing Hip or Knee Arthroplasty
Variable
Infected (vs noninfected) Age ≥ 65 y (vs <65 y) Female (vs male)
Hip replacements (vs knee) First Nation (vs non)
Comorbidities Congestive heart failure Diabetes
Diabetes with chronic complications Metastatic cancer Hypertension Renal failure
Elixhauser index 1 or 2 (vs 0) Elixhauser index ≥ 3 (vs 0)
Coefficient 34,276 3,312 209
2,596 1,559
15,649 − 1,598 4,336 8,623
− 3,422 14,199 4,291 6,852
P Value <.001 <.001 .694
<.001 .176
<.001 .243
<.001 .073
<.001 <.001 <.001 <.001
Elissa D. Rennert-May et al
3. Total hip and total knee replacement. The Joint Commission website.
https://www.jointcommission.org/total_hip__total_knee_replacement_/. Published 2017 Accessed April 2, 2018.
4. Hospitalizations, early revisions and infections following joint replace- ment surgery. Canadian Institute for Health Information website. https://
secure.cihi.ca/free_products/joint_complications_aib_e.pdf. Published 2008. Accessed March 15, 2018.
5. Miletic KG, Taylor TN, Martin ET, Vaidya R, Kaye KS. Readmissions after diagnosis of surgical site infection following knee and hip arthroplasty. Infect Control Hosp Epidemiol 2014; 35:152–157.
6. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2018; 36:309–332.
7. Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2013; 56:e1–e25.
8. Zimlichman E, Henderson D, Tamir O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013; 173:2039–2046.
9. Tansey R, Mirza Y, Sukeik M, Shaath M, Haddad FS. Definition of periprosthetic hip and knee joint infections and the economic burden. Open Orthop J 2016;10:662–668.
10. Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012;27:61–65.
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In conclusion, we estimated the incremental cost of managing
patients with complex SSI following primary hip or knee arthroplasty, noting a difference in total mean 1-year costs of more than $75,000 (US$ 53,621). Future research should consider the cost-effectiveness of different methods to prevent complex SSI following arthroplasty. Infectious diseases physicians should be encouraged to work with orthopedic surgeons and hospital administrators to promote the implementation of cost-effective strategies to prevent SSI.
Acknowledgments. We would like to thank the Alberta Bone and Joint Health Institute, the Alberta Health Services Infection Prevention and Control Surveillance Group, Alberta Health Services Microcosting and Alberta Health Services Analytics for their assistance in collecting and preparing the data used for this research project.
Financial support. No financial support was provided relevant to this article.
Conflicts of interest. All authors report no conflicts of interest relevant to this article.
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