Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
J Arthroplasty. 2021 Jul;36(7S):S160-S167. doi: 10.1016/j.arth.2021.02.034. Epub 2021 Feb 16.
With increases in total hip arthroplasty procedures the need for revision total hip arthroplasty (rTHA) has increased as well. This study aims to analyze the trends in hospital charges and payments relative to corresponding surgeon charges and payments in a Medicare population for rTHA for aseptic revisions, stage 1 and stage 2 revisions.
The 5% Medicare sample database was used to capture hospital and surgeon charges and payments related to 4449 patients undergoing aseptic revision, 517 for stage 1 revision, and 300 for stage 2 revision in between the years 2004 and 2014. Two values were calculated: (1) the ratio of hospital to surgeon charges (CM) and (2) the ratio of hospital to surgeon payments (PM). Year-to-year variation and trends in patient demographics, Charlson Comorbidity Index (CCI), length of stay (LOS), CM, and PM were evaluated.
The mean CCI for aseptic revisions and stage 1 revisions did not significantly change (P < .088 and P < .063). The CCI slightly increased for stage 2 revisions (P < .04). The mean LOS decreased significantly over time in all 3 procedure types. The CM increased by 39% (P < .02) in aseptic revisions, 109% in stage 1 revisions (P < .001) but did not significantly change in stage 2 revisions (P < .877). PM for aseptic revisions increased around 103% (P < .001), 107% for stage 1 revisions (P < .001), and 9.7% for stage 2 revisions (P < .176).
Hospital charges and payments relative to surgeon charges and payments have increased substantially for THA aseptic revisions, stage 1 revisions, and stage 2 revisions despite stable patient complexity and decreasing LOS.
随着全髋关节置换术数量的增加，翻修全髋关节置换术（rTHA）的需求也随之增加。本研究旨在分析在 Medicare 人群中，对于无菌性翻修、1 期和 2 期翻修，与相应外科医生收费和支付相关的医院收费和支付的趋势。
使用 5% Medicare 样本数据库，对 2004 年至 2014 年间接受无菌性翻修的 4449 例患者、517 例 1 期翻修患者和 300 例 2 期翻修患者的医院和外科医生收费及支付情况进行了分析。计算了两个值：（1）医院与外科医生收费比（CM）；（2）医院与外科医生支付比（PM）。评估了患者人口统计学、Charlson 合并症指数（CCI）、住院时间（LOS）、CM 和 PM 的年际变化和趋势。
无菌性翻修和 1 期翻修的平均 CCI 没有明显变化（P<0.088 和 P<0.063）。2 期翻修的 CCI 略有增加（P<0.04）。所有 3 种手术类型的 LOS 均随时间显著降低。CM 在无菌性翻修中增加了 39%（P<0.02），在 1 期翻修中增加了 109%（P<0.001），但在 2 期翻修中没有明显变化（P<0.877）。PM 在无菌性翻修中增加了约 103%（P<0.001），在 1 期翻修中增加了 107%（P<0.001），在 2 期翻修中增加了 9.7%（P<0.176）。
尽管患者的复杂性和 LOS 都在稳定下降，但 THA 无菌性翻修、1 期翻修和 2 期翻修的医院收费和支付与外科医生收费和支付相比，大幅增加。
