Cost of periprosthetic joint infections

Objectives: This study aims to assess the cost of patients with and without prosthetic joint infections (PJI) following operations for either primary or aseptic revision arthroplasty in our hospital and to categorize the costs to analyze the cost differences between these two groups. Material and method: The patients who underwent primary arthroplasty or aseptic revision surgery on knee or hip joints and hospitalized between January 2014 - June 2018 in Atatürk Training and Research Hospital were screened for PJI. The patients diagnosed with PJI whose treatment ended by January 2019 were included in the PJI group. A total of 174 controls were enrolled. During these processes, all expenses for patients have been detected and each expense have been converted to dollar currency according to annual average exchange rates. Results: Of the 4321 patients who underwent knee and hip arthroplasty surgery, PJI was detected in 87 patients. As the control group, 174 patients were included. The mean age of the patients in the PJI group was 70 (38-87) years. Of the PJI group, 27 (31%) patients were men and 60 (69%) of them were women. The median age of the patients in the control group was 67 (30-94) years. Of the controls, 60 (34,5%) were men and 114 (65,5%) were women. It has been determined that 32-58 (36,8 %- 33,3%) patients underwent hip and 55-116 (63,2 %- 66,7%) underwent knee arthroplasty in the PJI and control groups, respectively. There was no difference between two groups in terms of comorbid conditions. When the expenditures made during hospitalization were evaluated; it has been determined that the cost was $ 1.677 ($ 554,4 -$ 13.605,2) per person in the PJI group, and $ 494 ($ 269,3 -$ 3.790,9) in the control group (p<0,001). In the PJI group, hospitalization, intensive care unit (ICU) hospitalization, blood center, laboratory, microbiology, radiology, consultation, antibiotic expenditure costs were statistically significantly higher than the control group (p<0,001). The cost of primary surgery and primary prosthesis were found similar in both groups, and an analysis in terms of the cost of revision prosthesis/spacer could not be conducted since the revision operation was not performed in the control group. It has been observed that the expense per person in the PJI group was 3.4 times higher than the control group. Discussion and Conclusion: The development of PJI is an undesirable complication after joint arthroplasty, leading to a significant increase in costs. This increase constitutes a serious economic burden. Therefore, the expenditures that occur in case of PJI development should be analyzed separately and the factors affecting them should be identified. The measures to reduce the costs should be assessed beginning from the group with the highest expenditure. But more importantly, the most substantial goal should be reducing the frequency of PJI and analyzing the predisposing factors and taking measures against them. In the current framework, further studies on risks for PJI development analysing the costs of PJI are required. Keywords: Prosthetic joint infection, arthroplasty, costs, health expenditures