Septic hip revision was more expensive, linked with longer stay vs. aseptic revision
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Results showed septic hip revision was more expensive and had a longer length of stay compared with aseptic revision. Single-stage reimplantation presented the best value for society for periprosthetic joint infection treatment.
“We definitely need adjustments in reimbursement on the coding and hopefully that will reflect the reimbursement,” Carlos A. Higuera-Rueda, MD, said in his presentation at the Musculoskeletal Infection Society Annual Meeting.
Higuera-Rueda and colleagues retrospectively categorized 473 patients who underwent approximately 600 unilateral total hip revisions based on whether they received an aseptic revision, irrigation and debridement for periprosthetic joint infection with insert exchange; explantation with or without a spacer; spacer-exchange, second-stage reimplantation or single-stage reimplantation. Researchers collected professional and technical charges and compared the total charges between patients who underwent aseptic revision with those who underwent septic revision.
“We had about 232 septic procedures vs. 364 aseptic procedures,” Higuera-Rueda said. “When we compared both groups, the only difference that we found in terms of demographics was BMI was slightly higher in the septic group in addition to having more males. But in terms of comorbidities, they were the same.”
Higuera-Rueda noted patients who underwent aseptic revision had a significantly shorter length of stay compared with the septic revision group.
“That is particularly true when we do explantation with and without a spacer, and spacer-exchange is the highest,” Higuera-Rueda said.
Patients who underwent septic revision had a significant increase in the percent of charges incurred, especially among patients who underwent explantation and spacer-exchange, according to Higuera-Rueda.
“Overall, when we looked at all types [of septic revision], the length of stay has a significant difference, almost twice for septic revisions, and when we look at the total hospital charges, it was almost 43% higher,” Higuera-Rueda said.
Perspective
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Michael J. O'Malley, MD, FAAOS
Carlos Higuera-Rueda, MD, and colleagues have highlighted the fact that revisions for periprosthetic joint infections are an enormous burden on the physicians and the facilities that take care of these difficult problems. These cases are more costly, time-consuming and the patients are often medically more challenging requiring a multidisciplinary approach while in the hospital and after discharge. Studies such as this one help to direct attention toward optimizing the treatment of these patients. Though one-stage revision is a more cost-effective treatment based on the results of this study, these procedures are more time-consuming for the surgeon and poorly reimbursed for the increased time and efforts that are involved in doing a one-stage revision properly. I commend Higuera-Rueda on his study and his efforts to bring attention to this topic.
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Villa JM, et al. Paper 987. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 5-6, 2022; Pittsburgh (hybrid meeting).
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