Orthopedics. 2022 Jan-Feb;45(1):19-24. doi: 10.3928/01477447-20211124-04. Epub 2021 Dec 2.
With increased emphasis on improving value in total hip arthroplasty (THA) and total knee arthroplasty (TKA) care, concerns exist about whether variability in hospital costs between facilities is justified. The purpose of this study was to compare index facility reimbursement among hospitals and short-term outcomes for patients undergoing primary THA and TKA. We queried a single private insurer's claims data, identifying all patients undergoing THA or TKA from 2015 to 2017 performed by 25 surgeons across 16 hospitals within our institution. Hospitals were divided into high- and low-cost facilities based on mean index reimbursement. We compared comorbidities, episode-of-care costs, and short-term outcomes between facilities and performed multivariate analyses. Of 2963 procedures, 1305 (44%) were performed at higher-cost hospitals. Higher-cost facilities had higher mean index reimbursement ($40,597 vs $26,781, <.0001) and higher mean Charlson Comorbidity Index (CCI; 0.32 vs 0.24, =.0029), but no difference in complications (2.2% vs 1.8%, =.3955) or readmissions (2.2% vs 1.5%, =.1490). On multivariate analyses, higher-cost facility increased index reimbursement by $13,780 (95% CI, $13,489-$14,071, <.0001) and discharge to facility risk (odds ratio [OR], 3.2; 95% CI, 1.9-5.4; <.0001), but not complication (OR, 1.2; 95% CI, 0.7-2.0; =.5983) or readmission (OR, 1.5; 95% CI, 0.9-2.6; =.1474) risks. Shifting 25% of patients with a CCI of 0 from higher- to lower-cost centers would have decreased inpatient facility costs by an estimated $3,582,784. Wide variability exists between hospital facility costs for THA and TKA without differences in short-term outcomes. Demand matching healthier patients to lower-cost facilities may significantly lower the overall procedural costs of THA and TKA. [. 2022;45(1):19-24.].
随着人们越来越重视提高全髋关节置换术 (THA) 和全膝关节置换术 (TKA) 的价值，人们开始关注医疗机构之间的医院成本差异是否合理。本研究旨在比较我院 25 名外科医生在 16 家医院进行的初次 THA 和 TKA 患者的指数治疗设施报销和短期治疗结果。我们查询了一家私人保险公司的理赔数据，确定了 2015 年至 2017 年期间所有接受 THA 或 TKA 治疗的患者，这些患者均由 25 名外科医生进行手术。根据指数报销平均值，将医院分为高成本和低成本设施。我们比较了设施之间的合并症、治疗费用和短期结果，并进行了多变量分析。在 2963 例手术中，有 1305 例（44%）在高成本医院进行。高成本医院的平均指数报销更高（$40597 比 $26781，<.0001），平均 Charlson 合并症指数（CCI）也更高（0.32 比 0.24，=.0029），但并发症发生率（2.2% 比 1.8%，=.3955）和再入院率（2.2% 比 1.5%，=.1490）没有差异。在多变量分析中，高成本设施增加了 13780 美元的指数报销（95%CI，$13489-$14071，<.0001）和出院到设施的风险（优势比[OR]，3.2；95%CI，1.9-5.4；<.0001），但没有并发症（OR，1.2；95%CI，0.7-2.0；=.5983）或再入院（OR，1.5；95%CI，0.9-2.6；=.1474）风险。将 CCI 为 0 的 25%的患者从高成本中心转移到低成本中心，预计将使住院设施成本降低 3582784 美元。THA 和 TKA 的医院设施成本存在很大差异，但短期结果没有差异。将更健康的患者需求与低成本设施相匹配，可能会显著降低 THA 和 TKA 的整体程序成本。
