Direct Hospital Cost Determinants Following Hip and Knee Arthroplasty

Abstract

Objective. Total joint arthroplasty (TJA) places a significant economic burden on health care resources. This cohort study examines the costs associated with arthroplasty in 827 patients undergoing hip and knee TJA from January 2011 to June 2012 at a single center in Melbourne, Australia. Methods. Data included total inpatient, outpatient, and readmissions costs in the 30 days following TJA. Factors associated with cost were modeled using negative binomial regression and extrapolated to the Australian population. Results. The base cost (i.e., the cost for a patient with no modifying factors) over the first 30 days following TJA was $13,060 Australian (AU) (interquartile range $12,126-14,067 AU). The median length of stay was 4 days (range 2-33 days) and 35 patients (4%) were readmitted in the first 30 days following index TJA, the majority of whom had a surgical site infection (SSI) (74%). The following factors were independently associated with increased costs: SSI, preoperative warfarin therapy, American Society of Anesthesiologists score of 3 or 4, hip TJA, increasing operation time, increasing postoperative blood transfusion requirements, other nosocomial infections, postoperative venous thromboembolism (VTE), pressure ulcers, postoperative confusion, and acute urinary retention. Based on data from the present study, the cost of TJA in Australia is estimated to exceed $1 billion AU per year. Preventable postoperative complications were major cost drivers: SSI and VTE added a further $97 million AU and $66 million AU, respectively, to arthroplasty costs in the first 30 days following surgery. Conclusion. This unique study has identified important factors influencing TJA costs and providing guidance for future research and resource allocation.

The value of inpatient rehabilitation after uncomplicated knee arthroplasty: a propensity score analysis

“…[10][11][12][13] We used a national cohort from hospitals with high volumes of arthroplasty procedures, and the characteristics of the unmatched cohort were typical for patients who undergo TKA in Australia. 4,8,17,20,21 Our matched cohort should therefore be a representative sample of such patients. Our PS strategy achieved acceptable matching between the cohorts on many variables purported to influence treatment allocation and outcomes.…”

“…1 This trend is consistent with those in other countries. 2,3 The procedure reduces pain, improves function, and enhances healthrelated quality of life, but is expensive; 4 TKA is often cited as a major driver of increases in private health insurance premiums. 5,6 An important but underappreciated contributor to the overall cost of TKA is post-operative care in an inpatient rehabilitation facility.…”

Thrombelastography coagulation index may be a predictor of venous thromboembolism in gynecological oncology patients

“…The national expenditure associated with DVT in the United States was estimated at US$1.5 billion in 1997 . Reducing the incidence of VTE to 2% would potentially lead to a saving of US$29 million . The American Society of Clinical Oncology Clinical Practice Guidelines recommended that thromboprophylaxis be considered for selected high‐risk patients with active cancer .…”

“…39 Reducing the incidence of VTE to 2% would potentially lead to a saving of US$29 million. 40 The American Society of Clinical Oncology Clinical Practice Guidelines recommended that thromboprophylaxis be considered for selected high-risk patients with active cancer. 41 We assessed the ability of TEG to identify patients with gynecologic cancers at risk of VTE.…”

Definition of Periprosthetic Hip and Knee Joint Infections and the Economic Burden

“…This dramatic increase in cost was due to a combination of factors including prolonged operating time, increased blood loss, complications and length of inpatient stay. A similar study of 827 THA and TKA patients in Australia reported an increase to the cost of arthroplasty of 61% in the presence of SSI adding an estimated AUS $97 million to Total Joint Arthroplasty costs in the first 30 days following surgery [22]. …”