Healthcare resource utilization and costs for hip dislocation following primary total hip arthroplasty in the medicare population

Mantel, Jack; Chitnis, A.S.; Ruppenkamp, J.; Holy, Chantal E.; Daccach, Juan

doi:10.1080/13696998.2020.1854989

Cited by 7 publications

(5 citation statements)

References 26 publications

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“…The mean cost of surgical treatment for dislocation was found to be £10,893 per case by Vanhegan et al 6 In the USA, Sanchez-Sotelo et al 2 found that revision procedures represented 148% of the cost of an uncomplicated primary THA. Recently, a large retrospective database analysis of USA Medicare patients by Mantel et al 5 found that cost increases with dislocation were $19,590 per patient over one year and $24,211 per patient over two years.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Previous studies evaluating the clinical and economic impact of the treatment of THA dislocation have mainly focused on the occurrence and cost of THA revision and have not comprehensively evaluated the long-term cumulative consequences of THA dislocation. [2][3][4][5] The decision to revise a THA after dislocation will only be made once several attempts at conservative treatment have been undertaken, and each of these treatment cycles carry cost and quality of life (QoL) consequences. Additionally, once successful treatment is completed, the patient with THA dislocation will require additional rehabilitation and may be at a higher risk of further complications.…”

Section: Introductionmentioning

confidence: 99%

“…The burden of THA dislocation has been shown to differ by study design, and by the patient populations and countries of analysis. 2,[4][5][6] To our knowledge, data regarding the real-world prevalence, treatment practice patterns, and clinical and economic burden of hip dislocation in England are not available. Hence, the objectives of the 12 Drug costs were obtained from the 2018 British National Formulary.…”

Section: Introductionmentioning

confidence: 99%

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Treatment patterns and clinical and economic burden of hip dislocation following primary total hip arthroplasty in England

Galvain

Mantel²,

Kakade³

et al. 2022

The Bone & Joint Journal

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Aims The aim of this study was to estimate the clinical and economic burden of dislocation following primary total hip arthroplasty (THA) in England. Methods This retrospective evaluation used data from the UK Clinical Practice Research Datalink database. Patients were eligible if they underwent a primary THA (index date) and had medical records available 90 days pre-index and 180 days post-index. Bilateral THAs were excluded. Healthcare costs and resource use were evaluated over two years. Changes (pre- vs post-THA) in generic quality of life (QoL) and joint-specific disability were evaluated. Propensity score matching controlled for baseline differences between patients with and without THA dislocation. Results Among 13,044 patients (mean age 69.2 years (SD 11.4), 60.9% female), 191 (1.5%) had THA dislocation. Two-year median direct medical costs were £15,333 (interquartile range (IQR) 14,437 to 16,156) higher for patients with THA dislocation. Patients underwent revision surgery after a mean of 1.5 dislocations (1 to 5). Two-year costs increased to £54,088 (IQR 34,126 to 59,117) for patients with multiple closed reductions and a revision procedure. On average, patients with dislocation had greater healthcare resource use and less improvement in EuroQol five-dimension index (mean 0.24 (SD 0.35) vs 0.44 (SD 0.35); p < 0.001) and visual analogue scale (0.95 vs 8.85; p = 0.038) scores, and Oxford Hip Scores (12.93 vs 21.19; p < 0.001). Conclusion The cost, resource use, and QoL burden of THA dislocation in England are substantial. Further research is required to understand optimal timing of revision after dislocation, with regard to cost-effectiveness and impact on QoL. Cite this article: Bone Joint J 2022;104-B(7):811–819.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment patterns and clinical and economic burden of hip dislocation following primary total hip arthroplasty in England

Galvain

Mantel²,

Kakade³

et al. 2022

The Bone & Joint Journal

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“…Previous studies have also reported dislocation as the most common reason for readmission after THA [16]. Mantel et al [26] analyzed Medicare claims for dislocations after THA and reported a 1.7% 1-year dislocation rate with an increase in costs of $20 000. Other literature has reported an increase in costs ranging from 19% to 342% [11,14,33].…”

Section: Discussionmentioning

confidence: 99%

Early Readmission and Revision After Total Joint Arthroplasty: An Analysis of Cause and Cost

Bido,

Torres,

Kaidi

et al. 2024

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Bundled payments for total joint arthroplasty (TJA) were instituted by the Centers for Medicare and Medicaid Services (CMS) to reimburse providers a lump sum for operative and 90-day postoperative costs. Gaining a better understanding of which TJA patients are at risk for early return to the operating room (OR) is critical in preoperative optimization of those with modifiable risks, which could improve bundled-payment performance. Purpose: We sought to identify the most common reason for readmissions, as well as patient characteristics and costs, associated with early return to the OR among TJA patients. Methods: This was a retrospective cohort study of Medicare patients who had undergone primary total hip or knee arthroplasty (THA or TKA) between 2013 and 2018 at a tertiary care hospital. We used the CMS research identifiable files database to identify the most common reasons for readmissions and revisions within 90 days of surgery. Total billing claims were used to determine the cost of early readmissions and revisions. Multivariate regression analysis was used to determine the characteristics associated with early readmission or revision. Results: Out of 20 166 primary TJA patients identified, we found 1349 readmissions (5.6%) and 163 (0.8%) revisions within 90 days of surgery. Dislocation was the most common indication for readmission, and periprosthetic joint infection was the most common indication for revision. Early return to the OR was associated with a mean $105,988 (standard deviation [SD] = $76,865) in CMS claims for the inpatient stay. Factors associated with a higher risk of early reoperation were female sex, THA, longer length of stay, and discharge to long-term care facility. Conclusions: This retrospective cohort study found that early return to the OR after TJA increased overall 90-day costs by 260%, suggesting that early reoperation might have a significant impact on bundled payments. Further study is warranted.

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“…Instability following total hip arthroplasty (THA) can be a devastating complication. Recurrent dislocations can lead to high patient and societal costs due to increased admissions and revision surgeries, as well as overall reduced patient satisfaction [ 1 , 2 ]. While modern dislocation rates in THA are relatively low at ∼1% [ 3 , 4 ], with approximately ∼400,000 primary THAs performed annually in the United States, this incidence rate still creates a significant healthcare burden [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Increased Cup Anteversion May Not Prevent Posterior Dislocation in Patients With Abnormal Spinopelvic Characteristics in Total Hip Arthroplasty

Grosso,

Plaskos,

Pierrepont

et al. 2023

Arthroplasty Today

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Healthcare resource utilization and costs for hip dislocation following primary total hip arthroplasty in the medicare population

Cited by 7 publications

References 26 publications

Treatment patterns and clinical and economic burden of hip dislocation following primary total hip arthroplasty in England

Treatment patterns and clinical and economic burden of hip dislocation following primary total hip arthroplasty in England

Early Readmission and Revision After Total Joint Arthroplasty: An Analysis of Cause and Cost

Increased Cup Anteversion May Not Prevent Posterior Dislocation in Patients With Abnormal Spinopelvic Characteristics in Total Hip Arthroplasty

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