A novel process to reduce the cost of admission for treatment of infected shoulder arthroplasty
Recommended Citation
Harley JD, Braman JP, Harrison AK, and Rao AJ. A Novel Process to Reduce the Cost of Admission for Treatment of Infected Shoulder Arthroplasty. J Shoulder Elbow Surg 2025.
Document Type
Article
Publication Date
3-20-2025
Publication Title
Journal of shoulder and elbow surgery
Abstract
BACKGROUND: With the rapidly increasing volume of total joint arthroplasty procedures, the incidence of periprosthetic joint infection (PJI) and its associated economic burden are expected to rise. Two-stage reimplantation, a common strategy for PJI management, is costly, as it requires multiple surgeries and hospitalizations, with total costs ranging from $35,000 to $42,000. Given the long hospital stays required for these patients, a quality improvement project was undertaken at the authors' institution to reduce cost of admission (COA) and length of stay (LOS).
METHODS: We conducted a retrospective review of patients treated for PJI of the shoulder at a single hospital within a large health system. Patients were included if they had a biopsy-proven shoulder PJI treated with 1 of 2 protocols: a conventional, inpatient focused approach or a new, outpatient focused approach. Conventional management involved prosthesis explantation with intraoperative cultures, antibiotic spacer placement, inpatient infectious disease consultation, and inpatient peripherally inserted central catheter placement. The new protocol consisted of outpatient infectious disease clinic referral and peripherally inserted central catheter placement prior to explantation and spacer placement. COA and LOS were compared between the 2 groups.
RESULTS: Sixteen patients were included, 8 in each group. Patients managed with the outpatient-focused protocol had a significantly reduced COA ($17,711 ± 4078) compared to the conventional protocol ($24,233 ± 4967) with a mean difference of $6521, representing a 26.9% cost reduction per patient (P = .006). LOS was significantly reduced in the outpatient-focused group (median: 1.35 days; interquartile range: 1.21-1.89) compared to the conventional protocol group (median: 2.52 days; interquartile range: 1.81-3.21) (U = 10.50; Z = -2.26; P = .024).
CONCLUSIONS: The pilot quality improvement initiative resulted in a 27% reduction in COA and a significantly reduced LOS for patients with shoulder PJI. This has broad implications across orthopedics for the management of periprosthetic joint replacement and potential for tremendous impact of reducing healthcare costs.
PubMed ID
40120640
ePublication
ePub ahead of print
