Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
J Arthroplasty. 2018 Sep;33(9):2734-2739. doi: 10.1016/j.arth.2018.05.015. Epub 2018 Jun 11.
Recently, a bundled payment model was implemented in the United States to improve quality and reduce costs. While hospitals may be rewarded for lowering costs, they may be financially exposed by high cost complications, the so-called bundle busters. We aimed at determining the incidence, etiology, and costs of postacute complications after total joint arthroplasty (TJA).
A retrospective study was conducted using a prospectively collected database of patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) from January 2015 to April 2016. Nurse navigators performed postoperative surveillance to identify patients with complications and unplanned clinical events in the 90-day postoperative period. This was combined with episode-of-care costs provided by third-party payers to derive the mean and per capita costs of postacute complications and clinical events.
Among 3018 THA and 5389 TKA patients, 3.35% of THA and 2.62% of TKA patients sought emergency department or urgent care services, 2.62% of THA and 3.69% of TKA patients required hospital readmission, and 3.99% of TKA patients required manipulation. Joint-related complications were more common following THA, whereas medical complications were more frequent after TKA. The most costly complications after THA were periprosthetic fracture, dislocation, and myocardial infarction, compared to deep infection, myocardial infarction, and pulmonary embolism after TKA.
Joint-related complications were among the most costly events after TJA, and given their higher incidence after THA, had a larger impact on per capita costs. Medical complications were more common after TKA and more costly. Despite these events, postacute complications made up less than 5% of the total 90-day costs of TJA.
最近，美国实施了一种打包付费模式，以提高质量并降低成本。虽然医院可能因降低成本而获得奖励，但它们可能会因高成本并发症而面临财务风险，即所谓的“捆绑破坏者”。我们旨在确定全关节置换术后（TJA）的急性后并发症的发生率、病因和成本。
对 2015 年 1 月至 2016 年 4 月期间接受初次全髋关节置换术（THA）或全膝关节置换术（TKA）的患者进行了一项回顾性研究。护士导航员进行术后监测，以确定术后 90 天内发生并发症和非计划临床事件的患者。将这与第三方付款人提供的医疗费用结合起来，得出急性后并发症和临床事件的平均和人均费用。
在 3018 例 THA 和 5389 例 TKA 患者中，3.35%的 THA 和 2.62%的 TKA 患者前往急诊或紧急护理服务，2.62%的 THA 和 3.69%的 TKA 患者需要住院再入院，3.99%的 TKA 患者需要操作。THA 后关节相关并发症更为常见，而 TKA 后则更为常见的是医疗并发症。THA 后最昂贵的并发症是假体周围骨折、脱位和心肌梗死，而 TKA 后则是深部感染、心肌梗死和肺栓塞。
关节相关并发症是 TJA 后最昂贵的事件之一，鉴于其在 THA 后发生率更高，对人均成本的影响更大。TKA 后医疗并发症更为常见且成本更高。尽管存在这些并发症，但 TJA 后急性后并发症仅占 90 天总费用的不到 5%。
