Aims Our aim was to estimate the total costs of all hospitalizations for treating periprosthetic joint infection (PJI) by main management strategy within 24 months post-diagnosis using activity-based costing. Additionally, we investigated the influence of individual PJI treatment pathways on hospital costs within the first 24 months. Methods Using admission and procedure data from a prospective observational cohort in Australia and New Zealand, Australian Refined Diagnosis Related Groups were assigned to each admitted patient episode of care for activity-based costing estimates of 273 hip PJI patients and 377 knee PJI patients. Costs were aggregated at 24 months post-diagnosis, and are presented in Australian dollars. Results The mean cost per hip and knee PJI patient was $64,585 (SD $53,550). Single-stage revision mean costs were $67,029 (SD $47,116) and $80,063 (SD $42,438) for hip and knee, respectively. Two-stage revision costs were $113,226 (SD $66,724) and $122,425 (SD $60,874) for hip and knee, respectively. Debridement, antibiotics, and implant retention in hips and knees mean costs were $53,537 (SD$ 39,342) and $48,463 (SD $33,179), respectively. Suppressive antibiotic therapy without surgical management mean costs were $20,296 (SD $8,875) for hip patients and $16,481 (SD $6,712) for knee patients. Hip patients had 16 different treatment pathways and knee patients had 18 treatment pathways. Additional treatment, episodes of care, and length of stay contributed to substantially increased costs up to a maximum of $369,948. Conclusion Treating PJI incurs a substantial cost burden, which is substantially influenced by management strategy. With an annual PJI incidence of 3,900, the cost burden would be in excess of $250 million to the Australian healthcare system. Treatment pathways with additional surgery, more episodes of care, and a longer length of stay substantially increase the associated hospital costs. Prospectively monitoring individual patient treatment pathways beyond initial management is important when quantifying PJI treatment cost. Our study highlights the importance of optimizing initial surgical treatment, and informs treating hospitals of the resources required to provide care for PJI patients.

中文翻译：

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使用基于活动的成本法估计髋关节和膝关节假体周围关节感染治疗的两年住院费用。


目的 我们的目标是使用基于活动的成本核算，通过主要管理策略估计诊断后 24 个月内治疗假体周围关节感染 （PJI） 的所有住院总费用。此外，我们调查了个体 PJI 治疗途径对前 24 个月内住院费用的影响。方法 使用来自澳大利亚和新西兰前瞻性观察队列的入院和手术数据，将澳大利亚精细诊断相关组分配给每个入院患者的护理事件，对 273 名髋关节 PJI 患者和 377 名膝关节 PJI 患者进行基于活动的成本估计。费用在诊断后 24 个月汇总，并以澳元表示。结果 每位髋关节和膝关节 PJI 患者的平均费用为 64,585 美元 （SD 53,550 美元）。髋关节和膝关节的单期翻修平均费用分别为 67,029 美元（47,116 新元）和 80,063 美元（42,438 新元）。髋关节和膝关节的两阶段翻修费用分别为 113,226 美元（66,724 新元）和 122,425 美元（60,874 新元）。髋关节和膝关节的清创、抗生素和植入物固位平均成本分别为 53,537 美元（39,342 新元）和 48,463 美元（33,179 新元）。没有手术治疗的抑制性抗生素治疗意味着髋关节患者的费用为 20,296 美元（SD 8,875 美元），膝关节患者的费用为 16,481 美元（SD 6,712 美元）。髋关节患者有 16 种不同的治疗途径，膝关节患者有 18 种治疗途径。额外的治疗、护理时间和住院时间导致费用大幅增加，最高可达 369,948 美元。结论 治疗 PJI 会产生巨大的成本负担，这在很大程度上受管理策略的影响。每年 PJI 发病率为 3,900 例，澳大利亚医疗保健系统的成本负担将超过 2.5 亿澳元。 额外手术、更多护理发作和更长住院时间的治疗途径大大增加了相关的住院费用。在量化 PJI 治疗成本时，前瞻性监测初始管理后的个体患者治疗途径很重要。我们的研究强调了优化初始手术治疗的重要性，并告知治疗医院为 PJI 患者提供护理所需的资源。