Conversion Total Hip Arthroplasty in the Era of Bundled Care Payments: Impacts on Costs of Care

Hunter, Michael D.; Desmarais, Jason; Quilligan, Edward J.; Scudday, Travis; Patel, Jay; Barnett, Steve; Gorab, Robert S.; Nassif, Nader

doi:10.1016/j.arth.2022.12.028

Cited by 3 publications

(4 citation statements)

References 38 publications

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“…However, due to grouping by CMS, by coding standards, these surgeries are classified as having equivalent outcomes. As revealed by the study, CRPP and IMN cohorts exhibit striking clinical differences, which agrees with literature investigating the incurred cost of various conversion THAs [ 7 ]. Our study paired with the existing literature suggests CMS should implement further distinction to address the clinical and cost [ 7 ] discrepancies in complexity between the 2 cohorts.…”

Section: Discussionsupporting

confidence: 90%

“…A recent retrospective matched cohort study evaluating direct and indirect costs of care for conversion THA supports the notion that conversion arthroplasty for the IMN group is more costly than for the CRPP group [ 7 ], likely due to the difference in clinical outcomes we reported. While our study did not specifically evaluate cost, prior studies showed that more resources used correlated with increased indirect and direct expenses [ 3 , 5 , 10 ].…”

Section: Discussionsupporting

confidence: 70%

“…In addition, prior hip arthroscopy was found to increase complication rate in conversion THA patients [ 6 ]. Increased conversion THA costs were found to be dependent on the prior fixation, with IMNs increasing costs by 57% and CRPP increasing costs by 10% [ 7 ]. While the study did evaluate increased costs, no clinical comparisons between CRPP and IMN (or any other implant) were made.…”

Section: Introductionmentioning

confidence: 99%

“…The primary objective of this study was to compare perioperative outcomes of 2 groups of conversion arthroplasty patients: those with prior IMNs and those with CRPPs. Based on previous literature [ 5 , 7 ], the group hypothesized that patients with IMNs requiring conversion arthroplasty would demonstrate worse perioperative outcomes and consume more resources than those with CRPP constructs. Discovering and quantifying these outcome differences, if any, will encourage medical code agencies to reevaluate these procedures.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Orthopedic Hardware Type Impacts Case Complexity in Conversion Total Hip Arthroplasty Surgery

Cardenas,

Pfeil,

Fertitta

et al. 2024

Arthroplasty Today

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Orthopedic Hardware Type Impacts Case Complexity in Conversion Total Hip Arthroplasty Surgery

Cardenas,

Pfeil,

Fertitta

et al. 2024

Arthroplasty Today

View full text Add to dashboard Cite

Indications and Outcomes of Conversion Total Hip Arthroplasty via the Anterior and Posterior Approaches

Crockatt,

El-Othmani,

Sarpong

et al. 2024

The Journal of Arthroplasty

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Surgical Time and Complication Risk in Conversion Total Hip Arthroplasty With Implant Removal: Finding an Optimal Surgical Duration

Moody,

Lam,

Parikh

et al. 2024

J Am Acad Orthop Surg

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Background: Although longer surgical times in primary total hip arthroplasty (THA) are associated with higher complication rates, this has yet to be explored in conversion THA. The purpose of this study is to investigate the relationship between surgical time and complications in the setting of conversion THA with implant removal. We aim to establish a length of surgery after which the risk of complications increases. Methods: This was a retrospective study conducted at a single institution. A total of 260 conversion THAs performed between 2015 and 2021 were included. An area under the curve (AUC) was constructed to determine a surgery time that increased the likelihood of complications. Logistic regressions were run to determine predictors for longer surgical times and complications. Results: The overall complication rate of conversion THA involving implant removal was 25.8% (67 patients). Surgical times greater than 114 minutes were found to be a predictor of complications (AUC: 0.700, 95% Confidence Interval [CI]: 0.630 to 0.771), with complications 6 times as likely in these cases (9.57% vs. 34.9%, P < 0.001). Regression analysis revealed that index implants of cephalomedullary nails (P < 0.001, odds ratio [OR]: 17.47) and dynamic hip screw plates (P < 0.001, OR: 10.9) were notable predictors of surgical times greater than 114 minutes along with higher body mass index (P = 0.005, OR: 1.10). Higher body mass index and surgical times greater than 114 minutes were also found to be predictors of complications (P = 0.035, OR: 0.93; P < 0.001, 6.37). Conclusion: Conversion THA cases involving implant removal that are longer than 114 minutes are associated with higher complication rates and revision surgeries. Conversion THA requiring implant removal of cephalomedullary nails or dynamic hip screw plates were predictors for longer surgical times. Improved surgical planning and perioperative patient optimization may be viable options to limit surgical times. This information can be used to counsel patients on the risk of complications and the possibility of a staged procedure if appropriate.

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Conversion Total Hip Arthroplasty in the Era of Bundled Care Payments: Impacts on Costs of Care

Cited by 3 publications

References 38 publications

Orthopedic Hardware Type Impacts Case Complexity in Conversion Total Hip Arthroplasty Surgery

Orthopedic Hardware Type Impacts Case Complexity in Conversion Total Hip Arthroplasty Surgery

Indications and Outcomes of Conversion Total Hip Arthroplasty via the Anterior and Posterior Approaches

Surgical Time and Complication Risk in Conversion Total Hip Arthroplasty With Implant Removal: Finding an Optimal Surgical Duration

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