INCIDENCE ON COST AND DURATION OF THERAPY OF POSSIBLE POSTOPERATIVE WOUND INFECTIONS FROM TRAUMA WITH PROSTHETIC DEVICES, PREVENTIVELY TREATED AND UNTREATED, USING ANTIBACTERIAL GELS AT P.O. SAN GIULIANO, ASL NAPLES 2 NORTH
Authors: Filoso Immacolata , Iacolare Maria Rosaria , Monti Ida , Tortora Attilio , Contiello Claudio , De Luca Assunta , Scarano Anna , Gerbi Giovanni , Mignano Gaetano , Falconio Lucio Marcello 
Published: October 2023

Introduction: Bacterial infections associated with implanted biomaterials represent the most significant complication in orthopedics, and they constitute the primary reason for the failure of primary hip and knee prostheses.The 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 of the technologies proposed for this purpose in clinical practice have already shown strong evidence of antibacterial effectiveness, safety, and resistance. The time is ripe for further development and experimentation of these technologies in a clinical context.
Material and Methods: The study was conducted by observing wounds within 6 months following the treatments, and the purpose of the work was to evaluate the cost and benefit aspects in patients treated with defensive antibacterial gels during orthopedic prosthetic and/or synthesis surgeries at the P.O. San Giuliano ASL Napoli 2 Nord. The aim was to assess the effectiveness of the treatment applied to patients who underwent orthopedic prosthetic and/or synthesis surgeries. The wound conditions of treated patients and untreated patients were compared at 6 months after orthopedic surgery. Simultaneously, the costs incurred by the National Health Service (SSN) and the related benefits obtained for the treated patients and untreated patients were also analyzed. This observational and retrospective study was conducted over 6 months on a cohort of 60 patients from the orthopedic department and outpatient clinic of P.O. San Giuliano ASL Napoli 2, who underwent post-traumatic interventions. The cohort was divided into two groups: Group A (gA) included 30 operated patients whose wounds and/or devices used were treated with gels designed for decontamination, aiming to prevent infections; Group B (gB) consisted of 30 operated patients who were not treated with any such device. The study involved a 6-month observation of both groups, evaluating the possible onset of infections, their  duration (until complete healing, including potential complications), and the average cost of the necessary treatment (monitoring the use of drugs, medical supplies, and devices).A value scale was established based on the average cost incurred and the average treatment duration for each of the 4 levels on the scale.
Results: At the end of the study period, 30 patients from the cohort were observed in group gA, and 30 in group gB.Within group gA, 2 patients experienced infections that positioned them in the first two levels of the scale, while in group gB, 8 patients required treatment for infections that placed them at different levels of the scale based on the treatment received and its associated cost. The economic impact is significant and variable, depending on the extent of usage indications (e.g., applying the device alone or as a carrier in combination with antibiotics in all subjects undergoing primary and revision arthroplasty surgeries, or fracture osteosynthesis, or only in a subset of them, e.g., patients selected at risk of infections, subjects undergoing prosthesis reimplantation, osteosynthesis of open traumatic fractures, etc.).
Conclusions:The management of an infection that develops after orthopedic prosthetic and/or synthesis surgery leads the patient to seek and rely on long-term medical follow-up visits and specialized nursing assistance. The total costs for the care of the 10 infected patients show that the overall expenditure related to the 8 patients in group gB is much higher than that of the total 2 patients in group gA, both because of the fivefold difference in terms of number, which demonstrates how treatment with antibacterial gel reduces the incidence of infections, and also because the infections that occurred in the case of the 2 patients in group gA are milder and more manageable. Also considering the costs related to the use of antibacterial gel on wounds and/or prosthetic/osteosynthesis devices, the economic savings are still significant  considering the cost of pharmacological treatments for infections and those for their potential complications.