Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA.
J Arthroplasty. 2022 Aug;37(8S):S742-S747. doi: 10.1016/j.arth.2022.01.048. Epub 2022 Jan 31.
Although studies have compared the claims costs of simultaneous and staged bilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA), whether a simultaneous procedure is cost-effective to the facility remains unknown. This study aimed to compare facility costs and perioperative outcomes of simultaneous vs staged bilateral THA and TKA.
We reviewed a consecutive series of 560 bilateral THA (170 staged and 220 simultaneous) and 777 bilateral TKA (163 staged and 451 simultaneous). Itemized facility costs were calculated using time-driven activity-based costing. Ninety-day outcomes were compared. Margin was standardized to unadjusted Medicare Diagnosis Related Group payments (simultaneous, $18,523; staged, $22,386). Multivariate regression was used to determine the independent association between costs/clinical outcomes and treatment strategy (staged vs simultaneous).
Simultaneous bilateral patients had significantly lower personnel, supply, and total facility costs compared with staged patients with no difference in 90-day complications between the groups. Multivariate analyses showed that overall facility costs were $1,210 lower in simultaneous bilateral THA (P < .001) and $704 lower in TKA (P < .001). Despite lower costs, margin for the facility was lower in the simultaneous group ($6,569 vs $9,225 for THA; $6,718 vs $10,067 for TKA; P < .001).
Simultaneous bilateral TKA and THA had lower facility costs than staged procedures because of savings associated with a single hospitalization. With the increased Medicare reimbursement for 2 unilateral procedures, however, margin was higher for staged procedures. In the era of value-based care, policymakers should not penalize facilities for performing cost-effective simultaneous bilateral arthroplasty in appropriately selected patients.
虽然有研究比较了同期双侧全髋关节置换术（THA）和全膝关节置换术（TKA）的索赔费用，但同期手术对医疗机构是否具有成本效益尚不清楚。本研究旨在比较同期与分期双侧 THA 和 TKA 的医疗机构成本和围手术期结果。
我们回顾了连续 560 例双侧 THA（170 例分期和 220 例同期）和 777 例双侧 TKA（163 例分期和 451 例同期）的病例。采用时间驱动的作业成本法计算分项医疗机构成本。比较了 90 天的结果。对边缘进行了标准化，以调整未调整的医疗保险诊断相关组支付（同期为 18523 美元，分期为 22386 美元）。使用多元回归分析来确定成本/临床结果与治疗策略（分期与同期）之间的独立关联。
同期双侧患者的人员、供应和总医疗机构成本明显低于分期患者，但两组 90 天并发症无差异。多变量分析显示，同期双侧 THA 的总医疗机构成本降低了 1210 美元（P <.001），TKA 降低了 704 美元（P <.001）。尽管成本较低，但同期组的医疗机构利润较低（THA 为 6569 美元，分期为 9225 美元；TKA 为 6718 美元，分期为 10067 美元；P <.001）。
同期双侧 TKA 和 THA 的医疗机构成本低于分期手术，因为单次住院治疗可节省费用。然而，随着医疗保险对 2 个单侧手术的报销增加，分期手术的利润更高。在基于价值的护理时代，政策制定者不应对医疗机构为适当选择的患者进行具有成本效益的同期双侧关节置换术进行处罚。
