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. 2017 Apr 19;1(1):15-18.
doi: 10.1016/j.jses.2017.02.001. eCollection 2017 Mar.

The hospital cost of two-stage reimplantation for deep infection after shoulder arthroplasty

Yaser M K Baghdadi  1 , Hilal Maradit-Kremers  1 , Taylor Dennison  1 , Jeanine E Ransom  1 , John W Sperling  1 , Robert H Cofield  1 , Joaquin Sánchez-Sotelo  1
Affiliations

The hospital cost of two-stage reimplantation for deep infection after shoulder arthroplasty

Yaser M K Baghdadi et al. JSES Open Access. .

Abstract

Background: The cost of treating infection after hip and knee arthroplasty is well documented in the literature. The purpose of this study was to determine the cost of two-stage reimplantation for deep infection after shoulder arthroplasty.

Methods: Between 2003 and 2012, 57 shoulders (56 patients) underwent a two-stage reimplantation for deep periprosthetic shoulder infection; implants placed at reimplantation included anatomic total shoulder arthroplasty (a-TSA) in 58%, reverse total shoulder arthroplasty (r-TSA) in 40%, and hemiarthroplasty (HA) in 2%. During the same timeframe, 2953 primary shoulder arthroplasties (2589 patients) were performed at the same institution (a-TSA in 55%, r-TSA in 28%, and HA in 17%). Total direct medical costs were calculated by using standardized, inflation-adjusted costs for services and procedures billed during hospitalization and were adjusted to nationally representative unit costs in 2013 inflation-adjusted dollars.

Results: The mean hospital cost (per shoulder) for two-stage reimplantation was $35,824 (95% CI: 33,363 to 38,285) and was significantly higher than for primary procedures (mean: $16,068; 95% CI: 15,823 to 16,314). Both Part A and Part B costs were significantly higher in two-stage reimplantation (p < 0.001). For part A (hospital services), the mean cost for two-stage reimplantation was $29,851 (95% CI: 27,741 to 31,960), compared to $13,508 (95% CI: 13,302 to 13,715) for primaries. For part B (professional costs), mean costs were $5973 (95% CI: 5493 to 6453) versus 2560 (95% CI: 2512 to 2608) respectively.

Conclusions: The hospital cost of two-stage reimplantation for the treatment of an infected shoulder arthroplasty is about two times higher than the cost of a primary shoulder arthroplasty.

Keywords: Arthroplasty; Complications; Cost; Infection; Outcomes; Periprosthetic infection; Replacement; Revision; Shoulder.

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