Rosas Samuel, Sabeh Karim G, Buller Leonard T, Law Tsun Yee, Roche Martin W, Hernandez Victor H
Department of Orthopedic Surgery, University of Miami, Miami, Florida; Department of Orthopedic Surgery, Holy Cross Hospital, Fort Lauderdale, Florida.
Department of Orthopedic Surgery, University of Miami, Miami, Florida.
J Arthroplasty. 2017 Jul;32(7):2082-2087. doi: 10.1016/j.arth.2017.02.039. Epub 2017 Feb 24.
Total hip arthroplasty (THA) costs are a source of great interest in the currently evolving health care market. The initiation of a bundled payment system has led to further research into costs drivers of this commonly performed procedure. One aspect that has not been well studied is the effect of comorbidities on the reimbursements of THA. The purpose of this study was to determine if common medical comorbidities affect these reimbursements.
A retrospective, level of evidence III study was performed using the PearlDiver supercomputer to identify patients who underwent primary THA between 2007 and 2015. Patients were stratified by medical comorbidities and compared using the analysis of variance for reimbursements of the day of surgery, and over the 90-day postoperative period.
A cohort of 250,343 patients was identified. Greatest reimbursements on the day of surgery were found among patients with a history of cirrhosis, morbid obesity, obesity, chronic kidney disease (CKD) and hepatitis C. Patients with cirrhosis, hepatitis C, chronic obstructive pulmonary disease, atrial fibrillation, and CKD incurred in the greatest reimbursements over the 90-day period after surgery.
Medical comorbidities significantly impact reimbursements, and inferentially costs, after THA. The most costly comorbidities at 90 days include cirrhosis, hepatitis C, chronic obstructive pulmonary disease, atrial fibrillation, and CKD.
在当前不断发展的医疗保健市场中，全髋关节置换术（THA）的成本备受关注。捆绑支付系统的启动促使人们对这一常见手术的成本驱动因素进行进一步研究。一个尚未得到充分研究的方面是合并症对THA报销的影响。本研究的目的是确定常见的内科合并症是否会影响这些报销情况。
使用PearlDiver超级计算机进行了一项回顾性、证据水平为III级的研究，以识别2007年至2015年间接受初次THA的患者。根据内科合并症对患者进行分层，并使用方差分析比较手术当天及术后90天的报销情况。
共识别出250,343名患者。有肝硬化、病态肥胖、肥胖、慢性肾脏病（CKD）和丙型肝炎病史的患者在手术当天获得的报销最多。肝硬化、丙型肝炎、慢性阻塞性肺疾病、心房颤动和CKD患者在术后90天内的报销费用最高。
内科合并症对THA后的报销情况有显著影响，并由此推断对成本也有显著影响。术后90天内成本最高的合并症包括肝硬化、丙型肝炎、慢性阻塞性肺疾病、心房颤动和CKD。
