Department of Orthopedic Surgery, NYU Langone Health, New York, NY.
J Arthroplasty. 2021 Jul;36(7):2263-2267. doi: 10.1016/j.arth.2020.11.036. Epub 2020 Dec 1.
The number of octogenarians requiring a total hip arthroplasty (THA) and/or total knee arthroplasty (TKA) will rise disproportionally in the coming decade. Although outcomes are comparable with younger patients, management of these older patients involves higher medical complexity at a greater expense to the hospital system. The purpose of this study was to compare the cost of care for primary THA and TKA in our bundled care patients aged ≥80 years to those aged 65-80 years.
A retrospective review of primary TKA (n = 641) and THA (n = 1225) cases from 2013 to 2017 was performed. Patient demographic and admission cost data were collected. Patients were grouped based on surgery type (ie, elective or nonelective THA/TKA) and age group (ie, older [≥80 years old] or younger [65-80 years old]). Multivariate regression analyses were used to account for demographic differences.
Elective primary THA in the older cohort (n = 157) cost 24.5% more than the younger cohort (n = 1025) (P < .0001). Elective primary TKA cases in the older cohort (n = 87) cost 17.0% more than the younger cohort's (n = 554) (P < .0001). For nonelective THA cases, the older cohort's (n = 29) episodes cost 39.1% more than the younger cohort (n = 14) (P < .0001). When comparing the <80 elective THA cohort (n = 1025) to the ≥90 cohort (n = 10), the cost difference swelled to 58.7% (P < .0001).
Although primary THA and TKA in ≥80-year-old patients yield similar outcomes, this study demonstrates that the additional measures required to care for older patients and ensure successful outcomes cost significantly more. Consideration should be given to age as a factor in determining reimbursement in a bundled payment system to reduce the incentive to restrict care to elderly patients.
在未来十年，需要全髋关节置换术（THA）和/或全膝关节置换术（TKA）的 80 岁以上患者数量将不成比例地增加。尽管与年轻患者的结果相当，但这些老年患者的管理涉及更高的医疗复杂性，对医院系统的花费也更大。本研究旨在比较我们的捆绑式护理患者中年龄≥80 岁的初次 THA 和 TKA 与年龄 65-80 岁的患者的护理费用。
对 2013 年至 2017 年的初次 TKA（n=641）和 THA（n=1225）病例进行回顾性研究。收集患者的人口统计学和入院费用数据。根据手术类型（即择期或非择期 THA/TKA）和年龄组（即≥80 岁或 65-80 岁）对患者进行分组。使用多变量回归分析来解释人口统计学差异。
择期初次 THA 在高龄组（n=157）的费用比年轻组（n=1025）高 24.5%（P<.0001）。高龄组（n=87）的择期初次 TKA 费用比年轻组（n=554）高 17.0%（P<.0001）。对于非择期 THA 病例，高龄组（n=29）的住院费用比年轻组（n=14）高 39.1%（P<.0001）。当比较<80 岁择期 THA 组（n=1025）与≥90 岁组（n=10）时，费用差异增加到 58.7%（P<.0001）。
尽管≥80 岁的初次 THA 和 TKA 患者的结果相似，但本研究表明，为确保老年患者获得成功的治疗效果而需要采取的额外措施成本要高得多。在捆绑式支付系统中，应考虑年龄作为确定报销的一个因素，以减少限制老年患者护理的激励措施。
