South Western Sydney Clinical School, South West Sydney Clinical School UNSW, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW, 2170, Australia.
BMC Health Serv Res. 2020 Nov 12;20(1):1036. doi: 10.1186/s12913-020-05892-1.
Total hip and total knee arthroplasties are among the most common types of surgery performed in Australia today and are effective treatments for severe osteoarthritis. However, the increasing financial burden on the health system owing to the increasing rates of surgery has led to a growing interest in improving the cost-effectiveness and safety of arthroplasty care. This study was designed to quantify the association between post-operative complications, a major cost driver, and the cost of investigations following total hip or knee arthroplasty.
This is a prospective cohort study of consecutive patients undergoing primary total hip or knee arthroplasty at an Australian public hospital. We measured the number and cost of imaging and pathology tests performed during the acute hospital stay and used linear regression to quantify the association between complication status and investigation costs.
Five hundred patients were included in the analysis. On average, those with complications received more tests, and more expensive tests. The mean combined cost of imaging and pathology tests in patients with no complications was AU$ 187 (SD: 12.0). In comparison, patients with minor complications had a mean additional cost of AU$ 270 (SD: 31.0), and those with major complications had a mean additional cost of AU$ 493 (SD: 54.2) (p < 0.001).
In patients undergoing hip or knee arthroplasty, investigation costs are substantially greater in the presence of either minor or major complications. With growing volumes of total hip and total knee arthroplasties, a potential focus of future research could include optimising investigation practices for patients with and without complications.
全髋关节和全膝关节置换术是当今澳大利亚最常见的手术类型之一，也是治疗严重骨关节炎的有效方法。然而，由于手术率的不断增加，给医疗系统带来的经济负担不断增加，这导致人们越来越关注提高关节置换护理的成本效益和安全性。本研究旨在定量分析术后并发症（主要成本驱动因素）与全髋关节或膝关节置换术后检查成本之间的关系。
这是一项对澳大利亚公立医院接受初次全髋关节或膝关节置换术的连续患者进行的前瞻性队列研究。我们测量了在急性住院期间进行的影像学和病理学检查的数量和成本，并使用线性回归来量化并发症状态与检查成本之间的关联。
共纳入 500 例患者进行分析。平均而言，有并发症的患者接受了更多的检查，且检查费用更高。无并发症患者的影像学和病理学检查总费用平均为 187 澳元（标准差：12.0）。相比之下，轻微并发症患者的平均额外费用为 270 澳元（标准差：31.0），严重并发症患者的平均额外费用为 493 澳元（标准差：54.2）（p<0.001）。
在接受髋关节或膝关节置换术的患者中，存在轻微或严重并发症的患者的检查费用显著增加。随着全髋关节和全膝关节置换术数量的不断增加，未来研究的潜在重点可能包括优化有并发症和无并发症患者的检查实践。
