Surgical site infection prevention following total hip arthroplasty in Australia: a cost-effectiveness analysis.

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  • Author(s): Merollini KM;Merollini KM; Crawford RW; Whitehouse SL; Graves N
  • Source:
    American journal of infection control [Am J Infect Control] 2013 Sep; Vol. 41 (9), pp. 803-9. Date of Electronic Publication: 2013 Feb 21.
  • Publication Type:
    Journal Article; Research Support, Non-U.S. Gov't
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Mosby Country of Publication: United States NLM ID: 8004854 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-3296 (Electronic) Linking ISSN: 01966553 NLM ISO Abbreviation: Am J Infect Control Subsets: MEDLINE
    • Publication Information:
      Original Publication: St. Louis, Mosby
    • Subject Terms:
      Arthroplasty, Replacement, Hip/*adverse effects ; Infection Control/*economics ; Infection Control/*methods ; Surgical Wound Infection/*epidemiology ; Surgical Wound Infection/*prevention & control; Aged ; Aged, 80 and over ; Antibiotic Prophylaxis/economics ; Antibiotic Prophylaxis/methods ; Australia/epidemiology ; Cost-Benefit Analysis ; Environment, Controlled ; Female ; Humans ; Male ; Middle Aged ; Surgical Wound Infection/economics
    • Abstract:
      Background: Surgical site infection (SSI) is associated with substantial costs for health services, reduced quality of life, and functional outcomes. The aim of this study was to evaluate the cost-effectiveness of strategies claiming to reduce the risk of SSI in hip arthroplasty in Australia.
      Methods: Baseline use of antibiotic prophylaxis (AP) was compared with no antibiotic prophylaxis (no AP), antibiotic-impregnated cement (AP + ABC), and laminar air operating rooms (AP + LOR). A Markov model was used to simulate long-term health and cost outcomes of a hypothetical cohort of 30,000 total hip arthroplasty patients from a health services perspective. Model parameters were informed by the best available evidence. Uncertainty was explored in probabilistic sensitivity and scenario analyses.
      Results: Stopping the routine use of AP resulted in over Australian dollars (AUD) $1.5 million extra costs and a loss of 163 quality-adjusted life years (QALYs). Using antibiotic cement in addition to AP (AP + ABC) generated an extra 32 QALYs while saving over AUD $123,000. The use of laminar air operating rooms combined with routine AP (AP + LOR) resulted in an AUD $4.59 million cost increase and 127 QALYs lost compared with the baseline comparator.
      Conclusion: Preventing deep SSI with antibiotic prophylaxis and antibiotic-impregnated cement has shown to improve health outcomes among hospitalized patients, save lives, and enhance resource allocation. Based on this evidence, the use of laminar air operating rooms is not recommended.
      (Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)
    • Contributed Indexing:
      Keywords: Decision making; Economic evaluation; Infection control; Orthopedics; Surgical wound infection
    • Publication Date:
      Date Created: 20130226 Date Completed: 20140502 Latest Revision: 20220318
    • Publication Date:
      20221213
    • Accession Number:
      10.1016/j.ajic.2012.11.015
    • Accession Number:
      23434381