Clinical effectiveness and cost-effectiveness of 2 management strategies for infected total hip arthroplasty in the elderly
Clinical effectiveness and cost-effectiveness of 2 management strategies for infected total hip arthroplasty in the elderly
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DOI：
10.1086/318502
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发表时间：
2001-02-01
影响因子：
11.8
通讯作者：
Goldie, SJ
中科院分区：
文献类型：
--
作者：
Fisman, DN;Reilly, DT;Goldie, SJ
全髋关节置换术后感染的最佳治疗对临床医生来说是一个重大挑战。置换关节成形术通常被提倡，但手术并发症率高且费用昂贵。保留假体的清创术发病率较低，但复发感染率较高。为了评估这两种策略在老年患者中的有效性和成本效益，我们使用马尔可夫模型模拟了65岁和80岁虚弱男性和女性的假设队列中患者的预期终生临床病程。初始清创和保留增加了预期寿命2.2-2.6质量调整生命月，并在所有队列中具有有利的成本效益比。结果对清创术后的年复发率和初次诊断感染时的年龄最为敏感。在缺乏前瞻性临床试验的情况下，清创术和保留术是治疗葡萄球菌或链球菌感染且假体未松动的老年人的合理策略。
Optimal management of infected total hip arthroplasty poses a major challenge to clinicians. Exchange arthroplasty is usually advocated but has high rates of surgical morbidity and is expensive. Debridement with prosthesis retention is associated with less morbidity, but high rates of relapsed infection have been described. To estimate the effectiveness and cost-effectiveness of these 2 strategies among older patients, we used a Markov model to simulate patients' projected lifetime clinical course in hypothetical cohorts of 65-year-old and frail 80-year-old men and women. Initial debridement and retention increased life expectancy 2.2-2.6 quality-adjusted life months and had a favorable cost-effectiveness ratio in all cohorts. Results were most sensitive to the annual rate of relapse after debridement and age at initial diagnosis of infection. In the absence of prospective clinical trials, debridement and retention is a reasonable strategy for treatment of older persons with staphylococcal or streptococcal infection and a nonloosened prosthesis.