title: Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision.
abstract: BACKGROUND
  The most common intermediate and long-term complications of total knee arthroplasty (TKA) include aseptic and septic failure of prosthetic joints. These complications cause suffering, and their management is expensive. In the future the number of revision TKA will increase, which involves a greater financial burden. Little concrete data about direct costs for aseptic and two-stage septic knee revisions with an in depth-analysis of septic explantation and implantation is available.
  
  
  OBJECTIVE
  A retrospective consecutive analysis of the major partial costs involved in revision TKA for aseptic and septic failure was undertaken to compare 1) demographic and clinical characteristics, and 2) variable direct costs (from a hospital department's perspective) between patients who underwent single-stage aseptic and two-stage septic revision of TKA in a hospital providing maximum care. We separately analyze the explantation and implantation procedures in septic revision cases and identify the major cost drivers of knee revision operations.
  
  
  METHODS
  A total of 106 consecutive patients (71 aseptic and 35 septic) was included. All direct costs of diagnosis, surgery, and treatment from the hospital department's perspective were calculated as real purchase prices. Personnel involvement was calculated in units of minutes.
  
  
  RESULTS
  Aseptic versus septic revisions differed significantly in terms of length of hospital stay (15.2 vs. 39.9 days), number of reported secondary diagnoses (6.3 vs. 9.8) and incision-suture time (108.3 min vs. 193.2 min). The management of septic revision TKA was significantly more expensive than that of aseptic failure ($12,223.79 vs. $6,749.43) (p <.001). On the level of the separate hospitalizations the mean direct costs of explantation stage ($4,540.46) were lower than aseptic revision TKA ($6,749.43) which were again lower than those of the septic implantation stage ($7,683.33). All mean costs of stays were not comparable as they differ significantly (p <.001). Major cost drivers were the cost of the implant and general staff. The septic implantation part was on average $3,142.87 more expensive than septic explantations (p <.001).
  
  
  CONCLUSIONS
  Our study for the first time provides a detailed analysis of the major direct case costs of aseptic and septic revision TKA from the hospital-department's perspective which is the basis for long-term orientated decision making. In the future, our cost analysis has to be interpreted in relation to reimbursement estimates. This is important to check whether revision TKA lead to a financial loss for the operating department.
authors.affiliation: Center for Orthopedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Kasch
authors.affiliation: Center for Orthopedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Merk
authors.affiliation: Center for Orthopedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Grit
authors.initials: G
authors.lastname: Assmann
authors.affiliation: Center for Orthopedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany.|Kliniken Maria Hilf Mönchengladbach, Academic Teaching Hospital of the RWTH Aachen, Mönchengladbach, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Lahm
authors.affiliation: Center for Orthopedics, Trauma Surgery and Rehabilitation Medicine, Department of Trauma Surgery, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Napp
authors.affiliation: Center for Orthopedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Harry
authors.initials: H
authors.lastname: Merk
authors.affiliation: Department of Health Care Management, Faculty of Law and Economics, Ernst-Moritz-Arndt-University, Greifswald, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Flessa
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D018805:Sepsis