Insurance Status Affects In-Hospital Complication Rates After Total Knee Arthroplasty

Veltre, David R.; Yi, Paul H.; Sing, David C.; Curry, Emily J.; Endo, Atsushi; Smith, Eric L.; Li, Xinning

doi:10.3928/01477447-20180226-07

Cited by 27 publications

(25 citation statements)

References 30 publications

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“…Privately insured patients have been shown to have fewer medical complications and lower mortality rates when compared with Medicare patients undergoing primary THA and TKA [10,11]. In our study, nonagenarians were more often privately insured than octogenarians.…”

Section: Discussionmentioning

confidence: 55%

Differences in Hospital Costs among Octogenarians and Nonagenarians Following Primary Total Joint Arthroplasty

et al. 2021

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The proportion of patients over the age of 90 years continues to grow, and the anticipated demand for total joint arthroplasty (TJA) in this population is expected to rise concomitantly. As the country shifts to alternative reimbursement models, data regarding hospital expenses is needed for accurate risk-adjusted stratification. The aim of this study was to compare total in-hospital costs following primary TJA in octogenarians and nonagenarians, and to determine the primary drivers of cost. This was a retrospective analysis from a single institution in the U.S. We used time-drive activity-based costing (TDABC) to capture granular total hospital costs for each patient. 889 TJA’s were included in the study, with 841 octogenarians and 48 nonagenarians. Nonagenarians were more likely to undergo total hip arthroplasty (THA) (70.8% vs. 42.4%; p < 0.0001), had higher ASA classification (2.6 vs. 2.4; p = 0.049), and were more often privately insured (35.4% vs. 27.8%; p = 0.0001) as compared to octogenarians. Nonagenarians were more often discharged to skilled nursing facilities (56.2% vs. 37.5%; p = 0.0011), experienced longer operating room (OR) time (142 vs. 133; p = 0.0201) and length of stay (3.7 vs. 3.1; p = 0.0003), and had higher implant and total in-hospital costs (p < 0.0001 and 0.0001). Multivariate linear regression showed implant cost (0.700; p < 0.0001), length of stay (0.546; p < 0.0001), and OR time (0.288; p < 0.0001) to be the strongest associations with overall costs. Primary TJA for nonagenarians was more expensive than octogenarians. Targeting implant costs, length of stay, and OR time can reduce costs for nonagenarians in order to provide cost-effective value-based care.

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Section: Discussionmentioning

confidence: 55%

Differences in Hospital Costs among Octogenarians and Nonagenarians Following Primary Total Joint Arthroplasty

et al. 2021

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“…26,27 A later study found a more specific increased association of surgical site infections after spine surgery for Medicaid payors. 27 Other studies have also found associations between government funded insurance and complication rates in total hip arthroplasty, 28 total knee arthroplasty, 29 and shoulder arthroplasty. 30 Future studies with improved statistical power should analyze the association of insurance payor status and complication rates post pelvic fracture surgery.…”

Section: Discussionmentioning

confidence: 98%

Risk factors for complications following pelvic ring and acetabular fractures: A retrospective analysis at an urban level 1 trauma center

Henstenburg

Larwa

Williams

et al. 2021

Journal of Orthopaedics, Trauma and Rehabilitation

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Background: Pelvic ring and acetabular fractures are some of the most morbid in orthopedic trauma. They commonly require large exposures for fixation and are associated with significant morbidity and mortality. This study attempts to identify risk factors for complications following operative fixation of pelvic injuries. Methods: 126 patients treated for pelvic injuries were reviewed retrospectively. Demographics, procedure characteristics, and outcomes were recorded. Variables associated with complications were analyzed using logistic regression analysis. Results: Complications occurred in 12 patients. Higher BMI, longer length of stay, and ilioinguinal approach were significantly associated with increased infection risk. Co-morbid heart disease and concurrent smoking status showed a trend for increased infection risk. Higher BMI and ilioinguinal approach were significantly associated with an increased likelihood of re-operation. Positive psychiatric history and Medicaid payer status showed a trend toward higher reoperation risk. Conclusion: Knowledge of these risk factors can help guide management and predict outcomes following pelvic fracture fixation.

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“…In primary THAs and TKAs, patients with private payers were shown to have fewer complications and lower inpatient mortality rates compared to patients with government payers [18,19]. For rTKAs, Medicare insurance was found to be a risk factor correlated with increased readmission risk [20].…”

Section: Discussionmentioning

confidence: 99%

Episode-of-Care Costs for Revision Total Joint Arthroplasties by Decadal Age Groups

et al. 2021

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The demand for revision total joint arthroplasties (rTJAs) is expected to increase as the age of the population continues to rise. Accurate cost data regarding hospital expenses for differing age groups are needed to deliver optimal care within value-based healthcare (VBHC) models. The aim of this study was to compare the total in-hospital costs by decadal groups following rTJA and to determine the primary drivers of the costs for these procedures. Time-driven activity-based costing (TDABC) was used to capture granular hospital costs. A total of 551 rTJAs were included in the study, with 294 sexagenarians, 198 septuagenarians, and 59 octogenarians and older. Sexagenarians had a lower ASA classification (2.3 vs. 2.4 and 2.7; p < 0.0001) and were more often privately insured (66.7% vs. 24.2% and 33.9%; p < 0.0001) as compared to septuagenarians and octogenarians and older, respectively. Sexagenarians were discharged to home at a higher rate (85.3% vs. 68.3% and 34.3%; p < 0.0001), experienced a longer operating room (OR) time (199.8 min vs. 189.7 min and 172.3 min; p = 0.0195), and had a differing overall hospital length of stay (2.8 days vs. 2.7 days and 3.6 days; p = 0.0086) compared to septuagenarians and octogenarians and older, respectively. Sexagenarians had 7% and 23% less expensive personnel costs from post-anesthesia care unit (PACU) to discharge (p < 0.0001), and 1% and 24% more expensive implant costs (p = 0.077) compared to septuagenarians and octogenarians and older, respectively. Sexagenarians had a lower total in-hospital cost for rTJAs by 0.9% compared to septuagenarians but 12% more expensive total in-hospital costs compared to octogenarians and older (p = 0.185). Multivariate linear regression showed that the implant cost (0.88389; p < 0.0001), OR time (0.12140; p < 0.0001), personnel cost from PACU through to discharge (0.11472; p = 0.0007), and rTHAs (−0.03058; p < 0.0001) to be the strongest associations with overall costs. Focusing on the implant costs and OR times to reduce costs for all age groups for rTJAs is important to provide cost-effective VBHC.

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Insurance Status Affects In-Hospital Complication Rates After Total Knee Arthroplasty

Cited by 27 publications

References 30 publications

Differences in Hospital Costs among Octogenarians and Nonagenarians Following Primary Total Joint Arthroplasty

Differences in Hospital Costs among Octogenarians and Nonagenarians Following Primary Total Joint Arthroplasty

Risk factors for complications following pelvic ring and acetabular fractures: A retrospective analysis at an urban level 1 trauma center

Episode-of-Care Costs for Revision Total Joint Arthroplasties by Decadal Age Groups

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