The Cost and Outcome Effectiveness of Total Hip Replacement: Technique Choice and Volume–Output Effects Matter

Goldstein, Jonathan P.; Babikian, George; Rana, Adam J.; Mackenzie, J.; Millar, Andrew J.

doi:10.1007/s40258-016-0260-3

Cited by 8 publications

(6 citation statements)

References 46 publications

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“…53 papers (72.6%) reported the term anterolateral approach to describe a complete intermuscular approach between the interval between GM and TFL 3,8–51 most of the authors were from European countries, but authors from north America were also present.…”

Section: Resultsmentioning

confidence: 99%

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“Anterolateral” approach to the hip: a systematic review of the correct definition of terms

et al. 2020

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Purpose: The Watson-Jones interval plane between tensor fascia lata (TFL) and the gluteus medius (GM) has come back into fashion in the past few years - Röttinger described the anterolateral minimal invasive approach (ALMI) for use in total hip replacement, in which the standard Watson-Jones interval was used, but with a completely intermuscular plane. However, the term anterolateral is often still utilised to describe intramuscular approaches in which the GM was violated, thus creating a potential misunderstanding in the literature. Accordingly, we have designed a study to answer the following questions: (1) are there articles in the recent literature that use the term “anterolateral” to describe different approaches; (2) which would be the correct description of the anterolateral approach? Methods: We did a systematic review of the literature based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, to look for peer reviewed papers of any evidence level focusing on the definition of anterolateral approach; MEDLINE and EMBASE were searched. Results: 73 manuscripts met the criteria of the systematic search. 53 papers (72.6%) reported the term anterolateral approach to describe a complete intermuscular approach between the interval between GM and TFL. Nonetheless, in the remaining 20 papers (27.4%) the term anterolateral was used to describe intramuscular approaches in which the gluteus medius was violated. Conclusion: In about 1 out of 4 papers in the recent literature, the term anterolateral was utilised to describe approaches that are completely different both in terms of anatomy and function.

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Section: Resultsmentioning

confidence: 99%

“…"A reduced risk of dislocation with increased risk of aseptic revision was observed in the anterolateral transgluteal approach as compared with the posterior approach with a specific implant type" 15 Chomiak J et al 66 Hip Int 2015.…”

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confidence: 99%

“Anterolateral” approach to the hip: a systematic review of the correct definition of terms

et al. 2020

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“…The impact of centralization of healthcare activities on healthcare costs has been the topic of many recent studies. Centralization and reliance on newer surgical techniques of total hip replacement (THR) services have been shown to reduce costs [ 10 ]. Undergoing radical cystectomy at a high-volume medical center was associated with improved outcomes and reduced costs [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Centralization of surgical procedures includes concentration of resources, including staff, material and knowledge, allowing for high surgical volumes at a single site. Advocates of surgical centralization suggest that in a particular field the concentration of resources to highvolume centers may lead to improved quality of care and potentially increased economic efficiency [10][11][12][13]. The aim of this study was to investigate the difference in healthcare costs between a high surgical volume single site and low surgical volume multicenter sites using a mesh capturing device in a standardized surgical procedure.…”

Section: Introductionmentioning

confidence: 99%

Association between surgical volumes and real-world healthcare cost when using a mesh capturing device for pelvic organ prolapse: A 5-years comparison between single- versus multicenter use

et al. 2021

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Introduction and hypothesis The aim of this study was to evaluate whether high surgical volume at a single center was associated with lower healthcare costs compared to lower surgical volume in a multicenter setting. Methods All patients had symptomatic and anatomical apical prolapse (POP-Q ≥ stage II) with or without cystocele and were operated on by a standard surgical procedure using the Uphold mesh. Data on time of resource use in terms of surgery time, hospital stay and re-interventions across 5 years were compared between the single center (97 patients) and multicenter (173 patients, at 24 clinics). Unit costs for surgical time, inpatient and outpatient visits were extracted from the single-center hospital’s operation analysis program and prime production cost. Total costs were estimated for primary surgery and during 5-year follow-up. Results Costs for primary surgery were comparable between the single and the multicenter ($13,561 ± 2688 and $13,867 ± 1177, P = 0.29). Follow-up costs 5 years after primary surgery were 2.8 times higher at the multicenter than single center ($3262 vs. $1149, P < 0.001). Mean cost per patient over 5 years was significantly lower at the single than multicenter [$14,710 (CI: 14,168–15,252) vs. $17,128 (CI: 16,952–17,305), P < 0.001)]. Conclusions Using a mesh kit for apical pelvic organ prolapse in a high surgical volume center was associated with reduced healthcare costs compared with a lower volume multiple-site setting. The cost reduction at the high surgical volume center increased over time because of lower surgical and medical re-intervention rates for postoperative complications and recurrence.

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“…8,[16][17][18][19][20][21][22][23][24] As the authors discussed, Hasan et al 25 have demonstrated that most hip and knee surgery is performed by orthopedists who do a higher volume of cases, compared with shoulder arthroplasty. And although the orthopaedic literature [26][27][28][29] has shown a volume relationship to outcomes in total hip arthroplasty and total knee arthroplasty, it is much weaker than with TSA and rotator cuff repair. This might be explained by the experience effect on performance described by Gladwell, 30 where experience of 10,000 hours is associated with excellence in the performance of sports and other activities.…”

Section: See Related Article On Page 1273mentioning

confidence: 99%

Editorial Commentary: Volume and Outcome: 100 Years of Perspective on Value From E.A. Codman to M.E. Porter

Warner

Higgins

2017

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Outcome is the numerator for the value equation, with the denominator being cost; measurement of each is essential to determine the most effective care. With regard to both total shoulder arthroplasty and rotator cuff repair, outcomes of low (vs high) volume providers are associated with longer hospital stay, longer length of operating room time, increased hospital complications, and cost. This suggests that volume thresholds are a key to providing greater value. However, this effect can be modified through systematic efforts to measure outcome and thus improve. To quote Codman, "To effect improvement, the first step is to admit and record the lack of perfection. The next step is to analyze the causes of failure and to determine whether these causes are controllable." Thus, although volume most certainly plays a role in determining outcomes and cost, the more important principle is to measure outcomes and improve with such measurement.

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The Cost and Outcome Effectiveness of Total Hip Replacement: Technique Choice and Volume–Output Effects Matter

Abstract: Reliance on newer surgical techniques and centralization/regionalization of THR services can reduce costs.

Cited by 8 publications

References 46 publications

“Anterolateral” approach to the hip: a systematic review of the correct definition of terms

“Anterolateral” approach to the hip: a systematic review of the correct definition of terms

Association between surgical volumes and real-world healthcare cost when using a mesh capturing device for pelvic organ prolapse: A 5-years comparison between single- versus multicenter use

Editorial Commentary: Volume and Outcome: 100 Years of Perspective on Value From E.A. Codman to M.E. Porter

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