The Cost of Surgical Site Complications after TJA

    Editor’s Note: Research papers intended for presentation at the canceled annual meeting of the American Academy of Orthopaedic Surgeons are now available online at the AAOS Virtual Education Experience. We’ll be highlighting a few of the more interesting papers throughout the summer.

    Even if it does not progress to a deep periprosthetic joint infection (PJI), a surgical site complication in a Medicare patient who has undergone total joint arthroplasty (TJA) can be an expensive problem, costing nearly $5,000, according to a study from Columbia University Medical Center in New York.

    In a retrospective review, the researchers identified TJA patients on Medicare who underwent surgery at their institution between 2016 and 2018 and were subsequently diagnosed with a surgical site complication. Those who developed a PJI were excluded. The researchers then compared 90-day postoperative cost data from the Premier Healthcare Database for their TJA patients with and without surgical site complications.

    They found that the 90-day post-discharge cost for each patient with a surgical site complication was $4,705.18 higher than for a patient with an uncomplicated postoperative course ($14,738.89 versus $10,033.71), primarily for the cost of home services, laboratory services, emergency department visit, and medications. Most costs were incurred in the first 30 days after TJA: $3,206.36 for days 1 through 30 versus $1,944.52 for days 31 through 60. There were no differences in age, gender, body-mass index, or comorbidities between groups.

    “Superficial surgical site complications not associated with PJI still substantially increase postoperative resource utilization following elective TJA,” the researchers said, concluding that “[u]nder bundled healthcare models, increased attention should be given to preventative strategies.”


    Anatone A, Lauthen D, Shah RP, Geller JA, Cooper HJ. How Much Does a Surgical Site Complication Cost after Medicare Total Joint Arthroplasty? Paper 100. AAOS Virtual Education Experience.