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

Katharina Merollini; R W Crawford; S L Whitehouse; N Graves

doi:10.1016/j.ajic.2012.11.015

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

Journal article

Peer reviewed

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

Katharina Merollini, R W Crawford, S L Whitehouse and N Graves

American Journal of Infection Control, Vol.41(9), pp.803-809

2013

DOI: https://doi.org/10.1016/j.ajic.2012.11.015

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Abstract

economic evaluation

orthopedics

decision making

surgical wound infection

infection control

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.

Details

Title: Surgical site infection prevention following total hip arthroplasty in Australia: A cost-effectiveness analysis
Authors: Katharina Merollini (Author) - Queensland University of Technology
R W Crawford (Author) - Queensland University of Technology
S L Whitehouse (Author) - Queensland University of Technology
N Graves (Author) - Queensland University of Technology
Publication details: American Journal of Infection Control, Vol.41(9), pp.803-809
Publisher: Mosby, Inc.
Date published: 2013
DOI: 10.1016/j.ajic.2012.11.015
ISSN: 0196-6553
Organisation Unit: University of the Sunshine Coast, Queensland; School of Health and Sport Sciences - Legacy; School of Health and Behavioural Sciences - Legacy; School of Health - Public Health
Language: English
Record Identifier: 99450925902621
Output Type: Journal article

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Collaboration types: Domestic collaboration
Web Of Science research areas: Infectious Diseases; Public, Environmental & Occupational Health

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