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

Merollini, Katharina M.D., Crawford, Ross W., Whitehouse, Sarah L., & Graves, Nicholas (2013) Surgical site infection prevention following total hip arthroplasty in Australia : a cost-effectiveness analysis. American Journal of Infection Control, 41(9), pp. 803-809.

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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.


Baseline use of antibiotic prophylaxis (AP) was compared with no antibiotic prophylaxis (no AP), antibiotic-impregnated cement (AP þ ABC), and laminar air operating rooms (AP þ 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.


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 þ ABC)generated an extra 32 QALYs while saving over AUD $123,000. The use of laminar air operating rooms combined with routine AP (AP þ LOR) resulted in an AUD $4.59 million cost increase and 127 QALYs lost compared with the baseline comparator.


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.

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14 citations in Web of Science®

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ID Code: 59725
Item Type: Journal Article
Refereed: Yes
Keywords: Economic evaluation, Orthopedics, Decision making, Surgical wound infection, Infection control
DOI: 10.1016/j.ajic.2012.11.015
ISSN: 1527-3296
Divisions: Current > Schools > School of Chemistry, Physics & Mechanical Engineering
Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > QUT Faculties and Divisions > Science & Engineering Faculty
Current > Schools > School of Public Health & Social Work
Deposited On: 07 May 2013 22:27
Last Modified: 19 Jan 2016 04:55

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