Infection triples the cost of a primary joint arthroplasty

Puhto, Teija; Puhto, Ari‐Pekka; Vielma, Markku; Syrjälä, Hannu

doi:10.1080/23744235.2019.1572219

Cited by 45 publications

(47 citation statements)

References 28 publications

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“…Prosthetic joint infection (PJI) is a disastrous complication of modern orthopedic surgery, frequently leading to prolonged morbidity and even to increased mortality [1][2][3]. Moreover, therapy for PJI is associated with enormous costs [4][5][6]. Although international efforts to minimize the risk of these infections are ongoing, PJIs continue to develop in alarming numbers.…”

Section: Introductionmentioning

confidence: 99%

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Gallo

Nieslanikova

2020

JCM

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A projected increased use of total joint arthroplasties will naturally result in a related increase in the number of prosthetic joint infections (PJIs). Suppression of the local peri-implant immune response counters efforts to eradicate bacteria, allowing the formation of biofilms and compromising preventive measures taken in the operating room. For these reasons, the prevention of PJI should focus concurrently on the following targets: (i) identifying at-risk patients; (ii) reducing “bacterial load” perioperatively; (iii) creating an antibacterial/antibiofilm environment at the site of surgery; and (iv) stimulating the local immune response. Despite considerable recent progress made in experimental and clinical research, a large discrepancy persists between proposed and clinically implemented preventative strategies. The ultimate anti-infective strategy lies in an optimal combination of all preventative approaches into a single “clinical pack”, applied rigorously in all settings involving prosthetic joint implantation. In addition, “anti-infective” implants might be a choice in patients who have an increased risk for PJI. However, further progress in the prevention of PJI is not imaginable without a close commitment to using quality improvement tools in combination with continual data mining, reflecting the efficacy of the preventative strategy in a particular clinical setting.

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Section: Introductionmentioning

confidence: 99%

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Gallo

Nieslanikova

2020

JCM

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“…In the US, the annual costs associated with revision hip replacement after septic loosening increased from 320 million to 566 million dollars during the period 2001 to 2009 [28,29]. A study in Finland found that periprosthetic infection increased treatment costs threefold compared to uncomplicated primary THA [30].…”

Section: Discussionmentioning

confidence: 99%

“…LOS is thought to have the greatest influence on inter alia the number of postoperative complications, the risk of hospital infection, the overall cost of therapy and the ultimate postoperative outcome [15,17,[21][22][23][24][25][26][27][28][29][30].…”

Section: Introductionmentioning

confidence: 99%

Comparison of clinical and economic outcomes between the direct anterior approach and the posterolateral approach for primary total hip arthroplasty

Skowronek

Dębiński²,

Maksymiuk-Kłos³

et al. 2020

Arch Med Sci

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Introduction: Total hip arthroplasty (THA) is one of the most frequently performed surgical procedures in orthopedics. The most commonly employed approaches are the posterolateral approach (PLA) and the lateral approach. Minimally invasive techniques such as direct anterior approach (DAA) and MIS DAA (minimal invasive surgery direct anterior approach) are used more and more often. The aim of the study was to compare the two approaches DAA and PLA in terms of length of stay, economic outcomes, quality of life, hip joint function and hip joint awareness. Material and methods: The study was performed as a retrospective analysis of 52 cementless total hip arthroplasty procedures performed by MIS DAA and 56 cementless THA performed by classic standard PLA. The evaluation of hip joint awareness, quality of life, hip joint fitness assessment and economic indicators were evaluated. Results: The mean duration of the anterior approach procedure (48.96 minutes) was found to be around half that of the posterior approach (102.52 minutes) (Levene's test: F = 2.37; p > 0.005). The mean durations of the two types of approaches were found to be significantly different (Student's t test: t (106) =-16.15; p < 0.005). The shorter mean duration of stay and shorter procedure duration associated with the anterior approach result in mean savings of PLN 5465.96 per procedure. Conclusions: The MIS DAA procedure is a safe and less traumatizing surgical approach for hip arthroplasty which allows faster post-operative primary mobilization, shorter procedure time and sooner discharge from hospital than standard PLA. Significant reduction in costs of hospitalization was observed in the MIS DAA procedure.

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“…Furthermore, S. epidermidis is a common causative microorganism in infections in immunocompromised patients, including preterm infants and patients with hematological malignancies [4,8,9]. These infections result in large economic costs for society [10,11], and can have major adverse impact on patients' quality of life [12].…”

Section: Introductionmentioning

confidence: 99%

The Epidome - A species-specific Approach to Assess the Population Structure and Heterogeneity of Staphylococcus Epidermidis Colonization and Infection

Rendboe

Johannesen

Ingham

et al. 2020

Preprint

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BackgroundAlthough generally known as a human commensal, Staphylococcus epidermidis is also an opportunistic pathogen that can cause nosocomial infections related to foreign body materials and immunicompromized patients. Infections are often caused by multidrug resistant (MDR) lineages that are difficult and costly to treat, and can have a major adverse impact on patients’ quality of life. Heterogeneity is a common phenomenon in both carriage and infection, but present methodology for detection of this is laborious or expensive. In this study, we present a culture-independent method, labelled Epidome, based on an amplicon sequencing-approach to deliver information beyond species level on primary samples and to elucidate clonality, population structure and temporal stability or niche selection of S. epidermidis communities. MethodsBased on an assessment of >800 genes from the S. epidermidis core genome, we identified genes with variable regions, which in combination facilitated the differentiation of phylogenetic clusters observed in silico, and allowed classification down to lineage level. A duplex PCR, combined with an amplicon sequencing protocol, and a downstream analysis pipeline were designed to provide subspecies information from primary samples. Additionally, a probe-based qPCR was designed to provide valuable absolute abundance quantification of S. epidermidis. ResultsA combined laboratory and bioinformatic approach was successfully designed and validated on isolates representing skin commensals and on genomic mock communities to validate primer specificity and reproducibility using technical replicates. The method was furthermore applied to a sample set of primary skin and nasal samples, revealing a high degree of heterogeneity in the S. epidermidis population at both sampling sites with resolution down to distinct lineages. Additionally, the qPCR, with a detection limit of <10 copies/µL, showed a high degree of variation in absolute abundance of S. epidermidis.ConclusionsThe Epidome method is designed for use on primary samples to obtain information on S. epidermidis abundance and diversity beyond species-level to answer important questions regarding the emergence and dissemination of nosocomial lineages, investigating clonality of S. epidermidis communities, population dynamics, and niche selection. Our targeted-sequencing method allows rapid differentiation and identification of clinically important nosocomial lineages in primary low-biomass samples such as skin samples.

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Infection triples the cost of a primary joint arthroplasty

Cited by 45 publications

References 28 publications

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Comparison of clinical and economic outcomes between the direct anterior approach and the posterolateral approach for primary total hip arthroplasty

The Epidome - A species-specific Approach to Assess the Population Structure and Heterogeneity of Staphylococcus Epidermidis Colonization and Infection

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