Comparison of the Hospital Cost of Primary and Revision Total Hip Arthroplasty After Cost Containment

Abstract

This study compared the hospital cost of primary and revision total hip arthroplasty (THA) after the introduction of cost-containment programs (clinical pathway, hip implant standardization, and competitive bid purchasing of hip implants). Hospital financial records for 290 primary and 85 revision THAs performed from October 1993 through September 1995 were analyzed. A cost-accounting system provided actual hospital cost data for each procedure. Accurate calculation of hospital income or loss was determined. Average hospital length of stay was 4.9 days for primary THA and 5.9 days for revision THA. Average hospital cost was $11,104 for primary THA and $14,935 for revision THA. Average net income (hospital revenue - hospital expense) for primary THA was $2486. Average loss from revision THA was $401 . The payer mix included commercial insurance. Blue Cross/Blue Shield, managed care. Medicare, Medicaid, and workmen's compensation. For primary THA, all payers were profitable except Medicaid and selected managed care contracts. For revision THA, profit was achieved with payment from commercial insurance only. Despite the introduction of cost-containment programs, revision THA did not achieve profitability at our institution.

The Role of Preoperative Aspartate Aminotransferase-to-Platelet Ratio Index in Predicting Complications Following Total Hip Arthroplasty

“…To put this into context, while average hospital cost for primary THA has been shown to be around $11,104, costs for revision THA are around $14,935 and average loss of revenue to the hospital for the revision procedure is -$401. [24] In contrast, the blood tests needed to calculate APRI are routinely available at almost all hospitals and are very inexpensive, estimated at just a few dollars each.…”

Revision total knee arthroplasty results in financial deficits within the Swiss healthcare system

“…The uncovered costs of RTKA do not seem to be a burden for hospitals mainly performing PTKA, although there is a downward trend in reimbursement for PTKA in the United States [15]. However, as patients requiring RTKA often require more medical care due to additional, often serious medical comorbidities, and because of the technical complexity of some RTKA procedures, RTKA is often performed by tertiary hospitals [6, 9, 16, 22]. Thus, tertiary hospitals face a growing number of patients in need of RTKA, which fills their capacities with poorly reimbursed revision cases and leaves less capacity for them to perform PTKA.…”

“…The most common reasons for RTKA are infection or mechanical loosening [3]. Due to the complexity of RTKA and the fact that these patients often have serious medical comorbidities, potentially requiring intensive medical care, RTKA is predominantly performed in tertiary hospitals [6, 9, 16, 22]. However, the costs for RTKA are known to be considerably higher than those for PTKA, especially in case of septic two‐stage RTKA [7, 12, 23].…”

The role of preoperative aspartate aminotransferase-to-platelet ratio index in predicting complications following total hip arthroplasty

“…But evidence of this relationship and the use of APRI in screening high risk patients must be encouraged, as it can help prevent burden to the patient and to the healthcare system as a whole. To put this into context, while average hospital cost for primary THA has been shown to be around $11,104, costs for revision THA are around $14,935 and average loss of revenue to the hospital for the revision procedure is -$401 [ 24 ]. In contrast, the blood tests needed to calculate APRI are routinely available at almost all hospitals and are very inexpensive, estimated at just a few dollars each.…”