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The cost of managing complex surgical site infections following primary hip and knee arthroplasty: A population-based cohort study in Alberta, Canada

Published online by Cambridge University Press:  10 September 2018

Elissa D. Rennert-May ,
John Conly ,
Stephanie Smith ,
Shannon Puloski ,
Elizabeth Henderson ,
Flora Au  and
Braden Manns
Elissa D. Rennert-May
Affiliation:
Department of Medicine, University of Calgary, Calgary, Canada Department of Community Health Sciences, University of Calgary, Calgary, Canada
John Conly
Affiliation:
Department of Medicine, University of Calgary, Calgary, Canada Department of Immunology, Microbiology and Infectious Diseases, University of Calgary, Calgary, Canada Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada O’Brien Institute for Public Health, University of Calgary, Calgary, Canada Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Canada
Stephanie Smith
Affiliation:
Department of Medicine, University of Alberta, Edmonton, Canada
Shannon Puloski
Affiliation:
Department of Surgery, University of Calgary, Calgary, Canada
Elizabeth Henderson
Affiliation:
Department of Community Health Sciences, University of Calgary, Calgary, Canada
Flora Au
Affiliation:
Department of Medicine, University of Calgary, Calgary, Canada
Braden Manns*
Affiliation:
Department of Medicine, University of Calgary, Calgary, Canada Department of Community Health Sciences, University of Calgary, Calgary, Canada O’Brien Institute for Public Health, University of Calgary, Calgary, Canada Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
*
Author for correspondence: Braden Manns; HRIC Building, 2500 University Drive NW, Calgary, AB T2N1N4. E-mail: [email protected]
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Abstract

Objective

Nearly 800,000 primary hip and knee arthroplasty procedures are performed annually in North America. Approximately 1% of these are complicated by a complex surgical site infection (SSI), leading to very high healthcare costs. However, population-based studies to properly estimate the economic burden are lacking. We aimed to address this knowledge gap.

Design

Economic burden study.

Methods

Using administrative health and clinical databases, we created a cohort of all patients in Alberta, Canada, who received a primary hip or knee arthroplasty between April 1, 2012, and March 31, 2015. All patients who developed a complex SSI postoperatively were identified through a provincial infection prevention and control database. A combination of corporate microcosting data and gross costing methods were used to determine total mean 12- and 24-month costs, enabling comparison of costs between the infected and noninfected patients.

Results

Mean 12-month total costs were significantly greater in patients who developed a complex SSI compared to those who did not (CAD$95,321 [US$68,150] vs CAD$19,893 [US$14,223]; P < .001). The magnitude of the cost difference persisted even after controlling for underlying patient factors. The most commonly identified causative pathogen (38%) was Staphylococcus aureus (95% MSSA).

Conclusions

Complex SSIs following hip and knee arthroplasty lead to high healthcare costs, which are expected to rise as the yearly number of surgeries increases. Using our costing estimates, the cost-effectiveness of different strategies to prevent SSIs should be investigated.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 10 , October 2018 , pp. 1183 - 1188
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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