J A N U A R Y 2 0 1 7 O U T P A T I E N TS U R G E R Y. N E T 3 7
Orthopedic surgeons at
NYU Langone Medical
Center say primary knee
replacements cost about
$15,000, while perform-
ing revision surgery to
remove and replace an
infected implant can run
as much as $70,000.
They used the significant
cost of treating surgical site infections and the financial benefit of achieving even
a small reduction in the rate of post-op infections to drive implementation of a
universal screening program for Staphylococcus aureus at the Manhattan hospital.
James Slover, MD, an orthopedic surgeon at NYU Langone, helps lead the
program, which involves screening all total joint patients with nasal swabs
before surgery and prophylaxis treatment with the antibiotic mupirocin.
Patients are also asked to perform chlorhexidine showers the night before
surgery or use chlorhexidine wipes the night before and day of surgery.
The results of the screening are available the day of surgery. Patients who are
MRSA-negative receive standard perioperative antibiotic prophylaxis with either
cefazolin or clindamycin at least 30 minutes before incision time and for 24 hours
post-operatively. Patients who are MRSA-positive receive vancomycin intra-
venously at least 30 minutes before incisions are made and every 12 hours after
surgery for 24 hours.
Results from 1,300 patients who underwent the hospital's screening and decol-
onization protocol show the program reduced the post-op infection rate from
1.5% to 1%. As Joseph A. Bosco, MD, an orthopedic surgeon at NYU Langone,
• HIGH RISK Implants in total joint patients habor dangerous bacteria that can cause
surgical site infections.
PROVEN RESULTS
The Value of Preventing Post-op Infections
