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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

APIC: Joint replacement infections a crippling cost to patients, healthcare

San Antonio, TX: Given current population demographics, infection prevention following joint replacement surgery is emerging as a new priority to reduce health care costs and patient suffering.

In particular, preventing infectious complications following increasingly common knee and hip replacements could save the U.S. health care system some $65 million annually, according to an analysis to be presented today at the 39th Annual Educational Conference and International Meeting of the Association for Professionals in Infection Control and Epidemiology (APIC).

The research team, led by Keith Kaye, MD, MPH, corporate director of Infection Prevention, Hospital Epidemiology and Antimicrobial Stewardship at Detroit Medical Center/Wayne State University, analyzed data from health insurance claims for approximately 40 million insured individuals covered by employer-based health plans. Their goal was to uncover the rate of readmission and the financial impact of surgical site infections (SSI) beyond the initial hospitalization for that diagnosis.

The team chose to follow patients who had received artificial knees and hips because treatment for an infected joint can be prolonged, involving lengthy courses of antibiotics and additional surgeries.

Of the 174,425 patients in the database who underwent hip or knee replacement in 2007, 2,134 (1%) were hospitalized for a surgical site infection (SSI) within one year following their procedure. Of those, 267 (12.5%) were subsequently re-hospitalized in the year after the initial SSI hospitalization. The data also showed that another 870 patients with SSI (41%) were hospitalized for other reasons labeled “all cause” during the year after their diagnosis, accounting for another 1,770 readmissions.

In any case, rehospitalizations for an SSI are a costly event, with an average stay of 9 days, and $26,812 in additional costs. Rehospitalizations are a prime target for reduced CMS reimbursement, so preventing these infections is likely going to be driven in part by financial pressure from payers. A goal of the national Partnership for Patients – which includes CMS and many other major players in HAI prevention ---is to reduce hospital readmissions by 20% by the end of 2013 (from a 2010 baseline).