Profit-Influencing Factors in Orthopedic Surgery: An Analysis of Costs and Reimbursements

Abstract

The aging population and the associated demand for orthopedic surgeries are increasing health costs. Although the Diagnostic Related Groups (DRG) system was introduced to offer incentives for hospitals, concerns remain that reimbursements for older and frail patients do not cover all hospital expenses. We investigated further: (1) Does age influence net financial results in orthopedic surgery? (2) Are there patient or surgical factors that influence results? This retrospective, monocentric study compares costs and reimbursements for orthopedic patients in a tertiary care hospital in Switzerland between 2015 and 2017. The data of 1230 patients were analyzed. Overall, the net results for the hospital were positive, despite 19.5% of patients being treated at a loss. We did not find any correlation between age and profitability (p = 0.61). Patient-related factors associated with financial losses were female sex (p < 0.001) and diabetes (p = 0.013). Patients free of serious comorbidities (p = 0.012) or with a higher cost weight (p < 0.001) were more often profitable. A longer length of stay was associated with higher losses (p < 0.001). This is the first study to address the Swiss DRG reimbursement system in a broad orthopedic population, while also analyzing specific patient and surgical factors. Overall, the reimbursement system is fair, but could better account for certain interventions.

A Decade’s Perspective on the Orthopedic Workforce in Saudi Arabia

“…Obesity is linked to a higher incidence and progression of osteoarthritis in both weight-bearing joints like ankles, knees, and hips and non-weight-bearing joints like hand joints, as well as higher rates of joint replacements and surgical complications [ 2 ]. Furthermore, it has been speculated that the demand for orthopedic surgeons who address these patients will only rise in the coming years due to rising obesity rates among specific demographics, particularly the elderly [ 3 ]. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) have been identified as viable surgical therapeutic options for the therapy of osteoarthritis, involving the replacement of deteriorating joints with synthetic components that allow pain-free motion [ 4 ].…”

“…Throughout the last few decades, the proportion of women entering the medical field has steadily raised; currently, they account for roughly half of the medical schools [ 3 ]. As a result, more women are pursuing careers in surgical disciplines [ 2 ].…”

“…Orthopedic surgeons treat musculoskeletal diseases ranging from chronic to acute and life-threatening conditions. As a result, the orthopedic workforce is important in healthcare, and demand for such a workforce is predicted to rise as the population ages [ 2 , 3 ].…”

Recent Advancements in Metallic Drug-Eluting Implants

“…The volume of orthopedic surgeries is quickly increasing due to the aging population and osteoporosis’ significant increase, so the development of novel orthopedic implants is crucial [ 1 , 2 ]. Orthopedic implants accounted for $46.7 billion in the U.S. market in 2018, and are expected to grow to $66.0 billion by 2026 [ 3 ]. Joint reconstruction represents the largest share (41.2%) of the market, followed by spinal, trauma, orthobio-logics, and dental implants [ 4 ].…”

“…Joint reconstruction represents the largest share (41.2%) of the market, followed by spinal, trauma, orthobio-logics, and dental implants [ 4 ]. Approximately 22% and 16% of implant-related failures are caused by stress-shielding (i.e., Wolff’s principle) and infection, respectively [ 3 , 4 ]. A majority of orthopedic implants are made of metals and their alloys, such as titanium (Ti), tantalum (Ta), magnesium (Mg), zinc (Zn), stainless steels, and cobalt (Co)-based alloys, due to their low-cost and stability [ 5 , 6 ].…”