[The Economic Challenge of Centralised Treatment of Patients with Periprosthetic Infections].

INTRODUCTION: Periprosthetic infection (PJI) is one of the most severe complications in joint arthroplasty. Correct diagnosis and adequate therapy represent an enormous interdisciplinary challenge. The necessary interdisciplinarity and complexity of treatment require therapy in centres. However, the high costs have not yet been analysed or discussed and are problematic. The aim of this work is therefore to compare the costs within a year of treatment in a department specialised in the treatment of periprosthetic infections.

METHOD: A retrospective evaluation of the patients who were hospitalised in our Centre for Septic Surgery in 2015 was carried out using data from the hospital information system and medical controlling. Demographic data, diagnoses, the length of hospital stay, the number of surgical interventions and the pathogen spectrum were recorded and the costs of treatment were determined. These were compared to the DRG revenues.

RESULTS: A total of 281 patients were treated in 2015 due to an infection of the musculoskeletal system, 144 of these with a periprosthetic infection of the knee or hip joint (ratio 1.5 : 1). The mean duration of treatment was 16 days; the mean treatment costs per day and patient were approximately 820 €. The total cost of the 281 treatments was 3.3 million €, of which only 2.7 million were covered by DRG revenues (underfill of approx. - 20%). This corresponded to a deficit of 633,000 €, with a mean deficit per treatment case of 2300 €. The deficit for infected THA was 8585 € on average and was five times greater than for infected TKA - with 1638 €. The main reasons for the high treatment costs were the length of hospital stay, multiple surgical interventions and the isolation treatment.

CONCLUSION: The increasing number of PJI requires interdisciplinary treatment in centres. However, the costs not covered by the DRG system prevent such highly specialised treatment in centres, implying a loss of quality in treatment. There is an urgent need for social discussion and resolution.