Bacterial infections associated with implanted biomaterials represent the most significant complication in orthopedics, constituting the leading cause of failure in primary hip and knee prostheses. Prevention of infections associated with implanted biomaterials should simultaneously focus on at least two objectives: inhibition of biofilm formation and minimization of suppression of the local immune response. Some technologies proposed for this purpose in clinical practice have already demonstrated strong evidence of antibacterial efficacy, safety, and resistance. The time is ripe for further development and experimentation of these technologies in a clinical setting.
Materials and Methods
The study involved observing wounds in the 6 months following treatments (Follow Up). The aim was to evaluate the cost-benefit aspects in patients treated with defensive antibacterial gels during orthopedic interventions for prostheses and/or synthesis at the San Giuliano Hospital, ASL Napoli 2 North. The goal was to assess the effectiveness of the treatment applied to patients undergoing orthopedic interventions for prostheses and/or orthopedic synthesis. The wounds of treated and untreated patients were compared six months post-surgery, along with the costs incurred by the National Health Service (NHS) and the respective benefits obtained for treated and untreated patients. The observational and retrospective study spanned six months and involved a cohort of 60 patients from the orthopedic department and outpatient clinic of San Giuliano Hospital, ASL Napoli 2, undergoing post-traumatic interventions. The cohort was divided into two groups: Group A (gA) included 30 operated patients whose wounds or devices used were treated with decontamination gels to prevent infections, while Group B (gB) consisted of 30 patients operated on but not treated with any such device. The study involved a six-month observation of the two groups, evaluating the possible occurrence of infections, their duration (until complete healing, including any complications), and the average cost of therapy required for treatment (monitoring the use of drugs, supplies, and devices). A scale of values was then set up based on the average cost incurred and the average duration of treatment for each of the 4 levels of the scale.
At the end of the period, 30 patients from Group A and 30 from Group B were observed. Within Group A, 2 patients reported infections, placing them in the first two levels of the scale. In Group B, 8 patients required treatment for infections, placing them at different levels of the scale based on the treatment received and its associated cost. The economic impact is high and varies depending on the breadth of usage indications, such as applying the device alone or as a carrier in association with antibiotics for all subjects undergoing primary and revision arthroplasty or osteosynthesis surgical procedures, or only for a fraction of them (e.g., patients at risk of infections, subjects undergoing prosthesis re-implantation, osteosynthesis of traumatic exposed fractures, etc.).
Managing an infection that develops after an orthopedic intervention for prostheses and/or synthesis leads patients to seek long term medical check-ups and specialized nursing assistance. The total costs for treating the 10 infected patients show that the overall expenditure for the 8 in Group B is much higher than that for the total of 2 in Group A, both because of the fivefold increase in numbers and the milder and more treatable nature of infections in the two patients in Group A. Even when considering the costs related to the use of antibacterial gels on wounds or prosthetic devices/osteosynthesis, the economic savings are significant considering the cost of pharmacological treatments for infections and their potential complications.
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