How far does prophylaxis against infection in total joint replacement offset its cost?

Area of Science:

• Orthopedic Surgery
• Infectious Disease Prevention
• Health Economics

Background:

• Total joint replacement (TJR) surgery requires effective infection prophylaxis.
• Hospital surgical volume influences the cost-effectiveness of different prophylactic methods.

Purpose of the Study:

• To determine the most cost-effective method of infection prophylaxis for total joint replacement surgery.
• To analyze the economic impact of prophylaxis strategies in relation to hospital arthroplasty volume.

Main Methods:

• Comparative cost analysis of different prophylactic strategies (systemic antibiotics, local antibiotics, combined).
• Inclusion of reoperation costs for deep sepsis in total departmental cost calculations.
• Economic modeling incorporating the value of health loss to establish an economic optimum.

Main Results:

• At hospitals performing 100 arthroplasties annually, systemic antibiotics minimized total departmental costs.
• Local antibiotic prophylaxis (gentamicin-impregnated polymethylmethacrylate cement) or combined prophylaxis offered comparable costs and effects.
• Solely cost-driven selection of prophylaxis is suboptimal; incorporating health impact value identifies more effective strategies.

Conclusions:

• The optimal infection prophylaxis for total joint replacement is volume-dependent.
• A comprehensive economic evaluation, including health impact, is crucial for selecting superior prophylaxis methods.
• Advanced prophylaxis strategies can reduce infection incidence and reoperation rates, even if initially more costly.