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Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

BACKGROUND: The most common intermediate and long-term complications of total knee arthroplasty (TKA) include aseptic and septic failure of prosthetic joints. These complications cause suffering, and their management is expensive. In the future the number of revision TKA will increase, which involve...

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Autores principales: Kasch, Richard, Merk, Sebastian, Assmann, Grit, Lahm, Andreas, Napp, Matthias, Merk, Harry, Flessa, Steffen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5249079/
https://www.ncbi.nlm.nih.gov/pubmed/28107366
http://dx.doi.org/10.1371/journal.pone.0169558
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author Kasch, Richard
Merk, Sebastian
Assmann, Grit
Lahm, Andreas
Napp, Matthias
Merk, Harry
Flessa, Steffen
author_facet Kasch, Richard
Merk, Sebastian
Assmann, Grit
Lahm, Andreas
Napp, Matthias
Merk, Harry
Flessa, Steffen
author_sort Kasch, Richard
collection PubMed
description BACKGROUND: The most common intermediate and long-term complications of total knee arthroplasty (TKA) include aseptic and septic failure of prosthetic joints. These complications cause suffering, and their management is expensive. In the future the number of revision TKA will increase, which involves a greater financial burden. Little concrete data about direct costs for aseptic and two-stage septic knee revisions with an in depth-analysis of septic explantation and implantation is available. QUESTIONS/PURPOSES: A retrospective consecutive analysis of the major partial costs involved in revision TKA for aseptic and septic failure was undertaken to compare 1) demographic and clinical characteristics, and 2) variable direct costs (from a hospital department’s perspective) between patients who underwent single-stage aseptic and two-stage septic revision of TKA in a hospital providing maximum care. We separately analyze the explantation and implantation procedures in septic revision cases and identify the major cost drivers of knee revision operations. METHODS: A total of 106 consecutive patients (71 aseptic and 35 septic) was included. All direct costs of diagnosis, surgery, and treatment from the hospital department’s perspective were calculated as real purchase prices. Personnel involvement was calculated in units of minutes. RESULTS: Aseptic versus septic revisions differed significantly in terms of length of hospital stay (15.2 vs. 39.9 days), number of reported secondary diagnoses (6.3 vs. 9.8) and incision-suture time (108.3 min vs. 193.2 min). The management of septic revision TKA was significantly more expensive than that of aseptic failure ($12,223.79 vs. $6,749.43) (p <.001). On the level of the separate hospitalizations the mean direct costs of explantation stage ($4,540.46) were lower than aseptic revision TKA ($6,749.43) which were again lower than those of the septic implantation stage ($7,683.33). All mean costs of stays were not comparable as they differ significantly (p <.001). Major cost drivers were the cost of the implant and general staff. The septic implantation part was on average $3,142.87 more expensive than septic explantations (p <.001). CONCLUSIONS: Our study for the first time provides a detailed analysis of the major direct case costs of aseptic and septic revision TKA from the hospital-department’s perspective which is the basis for long-term orientated decision making. In the future, our cost analysis has to be interpreted in relation to reimbursement estimates. This is important to check whether revision TKA lead to a financial loss for the operating department.
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spelling pubmed-52490792017-02-06 Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision Kasch, Richard Merk, Sebastian Assmann, Grit Lahm, Andreas Napp, Matthias Merk, Harry Flessa, Steffen PLoS One Research Article BACKGROUND: The most common intermediate and long-term complications of total knee arthroplasty (TKA) include aseptic and septic failure of prosthetic joints. These complications cause suffering, and their management is expensive. In the future the number of revision TKA will increase, which involves a greater financial burden. Little concrete data about direct costs for aseptic and two-stage septic knee revisions with an in depth-analysis of septic explantation and implantation is available. QUESTIONS/PURPOSES: A retrospective consecutive analysis of the major partial costs involved in revision TKA for aseptic and septic failure was undertaken to compare 1) demographic and clinical characteristics, and 2) variable direct costs (from a hospital department’s perspective) between patients who underwent single-stage aseptic and two-stage septic revision of TKA in a hospital providing maximum care. We separately analyze the explantation and implantation procedures in septic revision cases and identify the major cost drivers of knee revision operations. METHODS: A total of 106 consecutive patients (71 aseptic and 35 septic) was included. All direct costs of diagnosis, surgery, and treatment from the hospital department’s perspective were calculated as real purchase prices. Personnel involvement was calculated in units of minutes. RESULTS: Aseptic versus septic revisions differed significantly in terms of length of hospital stay (15.2 vs. 39.9 days), number of reported secondary diagnoses (6.3 vs. 9.8) and incision-suture time (108.3 min vs. 193.2 min). The management of septic revision TKA was significantly more expensive than that of aseptic failure ($12,223.79 vs. $6,749.43) (p <.001). On the level of the separate hospitalizations the mean direct costs of explantation stage ($4,540.46) were lower than aseptic revision TKA ($6,749.43) which were again lower than those of the septic implantation stage ($7,683.33). All mean costs of stays were not comparable as they differ significantly (p <.001). Major cost drivers were the cost of the implant and general staff. The septic implantation part was on average $3,142.87 more expensive than septic explantations (p <.001). CONCLUSIONS: Our study for the first time provides a detailed analysis of the major direct case costs of aseptic and septic revision TKA from the hospital-department’s perspective which is the basis for long-term orientated decision making. In the future, our cost analysis has to be interpreted in relation to reimbursement estimates. This is important to check whether revision TKA lead to a financial loss for the operating department. Public Library of Science 2017-01-20 /pmc/articles/PMC5249079/ /pubmed/28107366 http://dx.doi.org/10.1371/journal.pone.0169558 Text en © 2017 Kasch et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Kasch, Richard
Merk, Sebastian
Assmann, Grit
Lahm, Andreas
Napp, Matthias
Merk, Harry
Flessa, Steffen
Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision
title Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision
title_full Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision
title_fullStr Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision
title_full_unstemmed Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision
title_short Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision
title_sort comparative analysis of direct hospital care costs between aseptic and two-stage septic knee revision
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5249079/
https://www.ncbi.nlm.nih.gov/pubmed/28107366
http://dx.doi.org/10.1371/journal.pone.0169558
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