title: Financial Analysis of Treating Periprosthetic Joint Infections at a Tertiary Referral Center.
abstract: Periprosthetic joint infection (PJI) is a significant challenge to the orthopedic surgeon, patient, hospital, and insurance provider. Our study compares the financial information of self-originating and referral 2-stage revision hip and knee surgeries at our tertiary referral center for hip or knee PJI over the last 4 years.
  
  
  
  We performed an in-house retrospective financial review of all patients who underwent 2-stage revision hip or knee arthroplasty for infection between January 2008 and August 2013, comparing self-originating and referral cases.
  
  
  
  We found an increasing number of referrals over the study period. There was an increased cost of treating hips over knees. All scenarios generated a positive net income; however, referral hip PJIs offered lower reimbursement and net income per case (although not statistically significant), whereas knee PJIs offered higher reimbursement and net income per case (although not statistically significant).
  
  
  
  With referral centers treating increased numbers of infected joints performed elsewhere, we show continued financial incentive in accepting referrals, although with less financial gain than when treating one's own hip PJI and an increased financial gain when treating referral knee PJIs.
authors.affiliation: Department of Orthopedics, Ochsner Clinic Foundation, New Orleans, Louisiana.
authors.forename: Bradford S
authors.initials: BS
authors.lastname: Waddell
authors.affiliation: Department of Orthopedics, Ochsner Clinic Foundation, New Orleans, Louisiana.
authors.forename: David C
authors.initials: DC
authors.lastname: Briski
authors.affiliation: Department of Orthopedics, Ochsner Clinic Foundation, New Orleans, Louisiana.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Meyer
authors.affiliation: Department of Orthopedics, Ochsner Clinic Foundation, New Orleans, Louisiana.
authors.forename: John L
authors.initials: JL
authors.lastname: Ochsner
authors.affiliation: Department of Orthopedics, Ochsner Clinic Foundation, New Orleans, Louisiana.
authors.forename: George F
authors.initials: GF
authors.lastname: Chimento
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000191:economics; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000191:economics; D005249:Fees and Charges; D017721:Hospital Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement; D016459:Prosthesis-Related Infections / Q000191:economics* / Q000209:etiology / Q000628:therapy*; D012017:Referral and Consultation / Q000191:economics; D012086:Reoperation / Q000191:economics; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000191:economics*
keywords: arthroplasty; cost; hip; knee; periprosthetic joint infection; referral