JBJI Journal of Bone and Joint Infection JBJI J. Bone Joint Infect. 2206-3552 Ivyspring Göttingen, Germany 10.7150/jbji.26146 Economic Analysis in a Diagnosis Related Groups System for Two-stage Exchange of Prosthetic-joint Infections Fischbacher Arnaud 1 Peltier Karine 1 Borens Olivier 1 Centre hospitalier universitaire vaudois (CHUV), Service d'orthopédie et de traumatologie, Rue du Bugnon 46, 1011 Lausanne, Switzerland. 24 11 2018 3 5 249 254 Copyright: © 2018 Arnaud Fischbacher et al. 2018 This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/ This article is available from https://jbji.copernicus.org/articles/3/249/2018/jbji-3-249-2018.html The full text article is available as a PDF file from https://jbji.copernicus.org/articles/3/249/2018/jbji-3-249-2018.pdf

<p class="p p-first" id="__p2"><strong>Background:</strong> There is a constant increase of joint arthroplasties performed, with an infectious risk of 1-2%. Different therapeutic options for prosthetic-joint infections exist, but surgery remains essential. With a two-stage exchange procedure, a success rate above 90% can be expected. Currently, there is no consensus regarding the optimal interval duration between explantation and reimplantation. This retrospective study aimed to assess the economic impact of a two-stage exchange from a single-hospital perspective.</p><p id="__p3"><strong>Methods:</strong> 21 patients who have undergone a two-stage exchange of a hip or knee prosthetic-joint infection at the University Hospital of Lausanne (Switzerland) from 2012 to 2013 were included. The revenues earned according to the Swiss Diagnosis Related Groups (SwissDRG) system introduced in 2012 and the costs were compared for each hospital stay.</p><p id="__p4"><strong>Results:</strong> The remuneration ranged from 26'806 to 42'978 Swiss francs (CHF) (~ 22'905-36'723 EUR, median 36'338 CHF, ~ 31'049 EUR). The median total cost per patient was 76'000 CHF (~ 65'000 EUR) (51'151 to 118'263; hip median 79'744, knee median 66'708). The main determinant of the costs was the length of the hospital stay. Revenues never covered all the costs, even with a short-interval procedure. The hospital lost a median of 35'000 CHF per patient (~ 30'000 EUR) (22'280 to 64'666).</p><p class="p p-last" id="__p5"><strong>Conclusion:</strong> The current DRG system may not be specific enough for rewarding prosthetic-joint infections. Several options could be considered to act on the length of the hospital stay. In order to cover costs in complicated cases, such as prosthetic-joint infections, more specific DRGs are needed.</p>

 References Borens O. et al. Diagnostic et traitement des infections d'implants orthopédiques. Rev Med Suisse. 2009;230:2563–2568. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-Joint Infections. N Engl J Med. 2004;351:1645–1654. Borens O. et al. Dix erreurs à ne pas commettre lors de la prise en charge d'une prothèse articulaire infectée en orthopédie. Rev Med Suisse. 2012;367:2452–2456. Sculco TP. The economic impact of infected total joint arthroplasty. Instr Course Lect. 1993;42:349–351. Haenle M, Skripitz C, Mittelmeier W, Skripitz R. Economic impact of infected total knee arthroplasty. ScientificWorldJournal. 2012;2012:196515. [PMC free article] Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty. 2008;23:984–991. Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012;27(8 Suppl):61–5. SwissDRG. [15.12.15] http://www.swissdrg.org. Stauber I, Angst F, Meier J, Lehmann S, Aeschlimann A, Michel B. Swiss Diagnosis Related Groups: A prospective study in rehabilitation comparing outcome before and after its introduction into acute health care. Swiss Med Wkly. 2014 [15.12.15] http://doi.emh.ch/smw.2014.14004. [PubMed] Busse R, Geissler A, Aaviksoo A, Cots F, Häkkinen U, Kobel C. et al. Diagnosis related groups in Europe: moving towards transparency, efficiency, and quality in hospitals? BMJ. 2013;346:f3197. Manuel de codage et circulaires. 2015 [15.12.15] http://www.bfs.admin.ch/bfs/portal/fr/index/infothek/nomenklaturen/blank/blank/codage/04/04_05.html#parsys_20081. Tarmedsuisse. [15.12.15] http://www.tarmedsuisse.ch. Lieb E, Hanstein T, Schuerings M, Trampuz A, Perka C. Reduction of Treatment Duration in Periprosthetic Infection with a Fast-Track Concept Is Economically Not Feasible. Z Orthopadie Unfallchirurgie; 2015. REKOLE® manuel, 4ème édition. 2013 [15.12.15] http://www.hplus.ch/fr/prestations/gestion/comptabilite_des_hopitaux/rekoler_manuel. Hellmann M, Mehta SD, Bishai DM, Mears SC, Zenilman JM. The Estimated Magnitude and Direct Hospital Costs of Prosthetic Joint Infections in the United States, 1997 to 2004. J Arthroplasty. 2010;25:766–771. Un hôtel trois étoiles logera les patients du CHUV. 24heures.ch. 2015 [15.12.15] http://www.24heures.ch/vaud-regions/hotel-trois-etoiles-logera-patients-chuv/story/16983531. Could state-funded patient hotels be the future? The Guardian. 2013 [15.12.15] http://www.theguardian.com/healthcare-network/2013/mar/26/state-funded-patient-hotels-future. Avec son futur hôtel des patients, le CHUV s'inspire de la Scandinavie. Letemps.ch. 2015 [15.12.15] http://www.letemps.ch/suisse/2015/06/23/futur-hotel-patients-chuv-s-inspire-scandinavie. Bulletin des médecins suisses. 2013 [15.12.15] http://www.bullmed.ch/archives/editions.html?tx_eps_toc%5Bissue%5D=105&tx_eps_toc%5Baction%5D=issue. Vaquero D, Fairen M, Torres A, Menzie AM, et al. Treatment of Periprosthetic Infections: An Economic Analysis. Sci World J. 2013. [15.12.15] http://www.hindawi.com/journals/tswj/2013/821650/abs/