Kamath Atul F, Chitnis Abhishek S, Holy Chantal, Lerner Jason, Curtin Brian, Lochow Steve, DeCook Charles, Matta Joel M
a Department of Orthopaedic Surgery , University of Pennsylvania , Philadelphia , PA , USA.
b Epidemiology Medical Devices, Johnson & Johnson Co , New Brunswick , NJ , USA.
J Med Econ. 2018 Feb;21(2):218-224. doi: 10.1080/13696998.2017.1393428. Epub 2017 Nov 3.
The anterior approach (AA) for total hip arthroplasty (THA) is associated with more rapid recovery when compared to traditional approaches. The purpose of this study was to benchmark healthcare resource utilization and costs for patients with THA via AA relative to matched patients.
This study queried Medicare claims data (2012-2014) to identify patients who received THA via an AA from experienced surgeons, and matched these patients to a control cohort (all THA approaches). Direct and propensity-score matching were employed to maximize similarity between patients and hospitals in the two cohorts. Hospital length of stay (LOS), the proportion of patients discharged to home or home health, and post-acute claim payments during the 90-day episode were assessed. Generalized estimating equations were applied to control for imbalances between the cohorts and clustering of outcomes within hospitals.
A total of 1,794 patients were included after patient matching. Patients who received AA had significantly lower mean hospital LOS vs patients in the control group (2.06 ± 1.36 vs 2.98 ± 1.58 days, p < .0001). The adjusted proportion of patients discharged to home was nearly 20 percentage points higher in the AA cohort vs the control cohort (87.3% vs 68.7%, p < .0001). Post-acute claim payments for AA patients were nearly 50% lower than those for control patients ($4,139 vs $7,465, p < .0001).
AA patients had significantly lower post-acute care resource use when compared to control patients. Further research is warranted to evaluate the cost effectiveness of AA among surgeons of varying experience levels.
与传统方法相比，全髋关节置换术（THA）的前路入路（AA）与更快的恢复相关。本研究的目的是对比接受AA的THA患者与匹配患者的医疗资源利用情况和成本。
本研究查询了医疗保险索赔数据（2012 - 2014年），以识别接受经验丰富的外科医生进行AA手术的THA患者，并将这些患者与一个对照队列（所有THA手术入路）进行匹配。采用直接匹配和倾向得分匹配，以使两个队列中的患者和医院之间的相似性最大化。评估了住院时间（LOS）、出院回家或接受家庭健康护理的患者比例以及90天内的急性后期索赔支付情况。应用广义估计方程来控制队列之间的不平衡以及医院内结果的聚类情况。
患者匹配后共纳入1794例患者。接受AA手术的患者的平均住院LOS显著低于对照组患者（2.06±1.36天对2.98±1.58天，p <.0001）。AA队列中出院回家的患者调整比例比对照队列高近20个百分点（87.3%对68.7%，p <.0001）。AA患者的急性后期索赔支付比对照患者低近50%（4139美元对7465美元，p <.0001）。
与对照患者相比，接受AA手术的患者的急性后期护理资源使用显著更低。有必要进一步研究以评估不同经验水平的外科医生中AA的成本效益。
