Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
J Arthroplasty. 2018 Dec;33(12):3607-3611. doi: 10.1016/j.arth.2018.08.035. Epub 2018 Sep 1.
Due to concerns about higher complication rates, surgeons debate whether to perform simultaneous bilateral total joint arthroplasty (BTJA), particularly in the higher-risk Medicare population. Advances in pain management and rehabilitation protocols have called into question older studies that found an overall cost benefit for simultaneous procedures. The purpose of this study was to compare 90-day episode-of-care costs between staged and simultaneous BTJA among Medicare beneficiaries.
We retrospectively reviewed a consecutive series of 319 simultaneous primary TJAs and 168 staged TJAs (336 procedures) at our institution between 2015 and 2016. We recorded demographics, comorbidities, readmission rates, and 90-day episode-of-care costs based upon Centers for Medicare and Medicaid Services claims data. To control for confounding variables, we performed a multivariate regression analysis to identify independent risk factors for increased costs.
Simultaneous patients had decreased inpatient facility costs ($19,402 vs $23,025, P < .001), increased post-acute care costs ($13,203 vs $10,115, P < .001), and no difference in total episode-of-care costs ($35,666 vs $37,238, P = .541). Although there was no difference in readmissions (8% vs 9%, P = .961), simultaneous bilateral patients were more likely to experience a thromboembolic event (2% vs 0%, P = .003). When controlling for demographics, procedure, and comorbidities, a simultaneous surgery was not associated with an increase in episode-of-care costs (P = .544). Independent risk factors for increased episode-of-care costs following BTJA included age ($394 per year increase, P < .001), cardiac disease ($4877, P = .025), history of stroke ($14,295, P = .010), and liver disease ($12,515, P = .016).
In the Medicare population, there is no difference in 90-day episode-of-care costs between simultaneous and staged BTJA. Surgeons should use caution in performing a simultaneous procedure on older patients or those with a history of stroke, cardiac, or liver disease.
由于担心更高的并发症发生率，外科医生对是否进行双侧同期全关节置换术（BTJA）存在争议，尤其是在风险较高的医疗保险人群中。疼痛管理和康复方案的进步使得人们对那些发现同期手术具有总体成本效益的旧研究提出了质疑。本研究旨在比较医疗保险受益人群中分期和同期 BTJA 的 90 天治疗费用。
我们回顾性分析了 2015 年至 2016 年我院连续进行的 319 例同期初次 TJAs 和 168 例分期 TJAs（336 例）的连续系列。我们根据医疗保险和医疗补助服务索赔数据记录人口统计学、合并症、再入院率和 90 天治疗费用。为了控制混杂变量，我们进行了多元回归分析，以确定增加成本的独立危险因素。
同期患者的住院设施费用降低（$19402 与$23025，P<0.001），术后康复费用增加（$13203 与$10115，P<0.001），但总治疗费用无差异（$35666 与$37238，P=0.541）。尽管再入院率没有差异（8%与 9%，P=0.961），但同期双侧患者更有可能发生血栓栓塞事件（2%与 0%，P=0.003）。在控制人口统计学、手术和合并症后，同期手术与治疗费用的增加无关（P=0.544）。BTJA 后治疗费用增加的独立危险因素包括年龄（每年增加$394，P<0.001）、心脏病（$4877，P=0.025）、中风史（$14295，P=0.010）和肝病（$12515，P=0.016）。
在医疗保险人群中，同期和分期 BTJA 的 90 天治疗费用无差异。对于老年患者或有中风、心脏或肝脏病史的患者，外科医生应谨慎进行同期手术。
