万古霉素预浸泡移植物在ACL重建术中的应用：基于法语关节镜学会注册数据的感染事件发生率与成本效益分析
简介
基于法语关节镜学会注册数据库的3,278例ACL重建患者（91.3%接受万古霉素预浸泡移植物），回顾性比较术后6个月感染性关节炎发生率并进行成本效果分析。结果显示万古霉素浸泡组感染率仅0.07%，虽与未浸泡组无统计学差异，但经济学模型提示该策略可节省医疗费用，预防1例感染需治疗556例患者。提示万古霉素预浸泡移植物是低感染率且经济有效的围术期预防措施，但受回…
英文摘要
BACKGROUND: Septic arthritis (SA) after anterior cruciate ligament reconstruction (ACLR) is a rare but serious complication with significant clinical and economic consequences. Presoaking ACL grafts in vancomycin has shown to reduce postoperative SA, but its effectiveness, cost-efficiency, and adoption in clinical practice remain debated. The objectives of this study were (1) to report the incidence of SA after ACLR when using a vancomycin pre-soaked graft compared to a non-pre-soaked graft, and (2) to conduct a cost-effectiveness analysis of this procedure based on healthcare costs in France. HYPOTHESIS: Vancomycin graft presoaking would represent a cost-effective preventive strategy within the French healthcare system. PATIENTS AND METHODS: A retrospective multicenter study was conducted using the Francophone Society of Arthroscopy (SFA) registry, including primary and revision ACLR performed between November 2021 and April 2024. A total of 3,278 patients were included, of whom 2,993 (91.3%) received vancomycin-soaked grafts and 285 (8.7%) received non-soaked grafts. Postoperative complications at 6 months, including septic arthritis, were recorded. A cost-effectiveness analysis compared both strategies using the observed registry infection rate in the vancomycin group together with a literature-derived baseline infection rate and French healthcare cost estimates. RESULTS: Two cases of SA (0.07%) were identified in the vancomycin group. There was no difference between the two groups in term of SA rates (p = 1.00). Cost-effectiveness analysis demonstrated that vancomycin presoaking was a dominant strategy, with lower expected costs. Based on the assumptions of the economic model, the number needed to treat to prevent one septic arthritis was estimated at 556 patients. DISCUSSION: Vancomycin graft presoaking was associated with a very low rate of postoperative septic arthritis and appeared to be a cost-saving preventive strategy in the economic model. However, the study was not powered to demonstrate a difference in infection rates between groups. LEVEL OF EVIDENCE: III; retrospective comparative study.