Department of Orthopaedic Surgery, NYU Langone Health, New York, New York; Division of Orthopaedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Department of Orthopaedic Surgery, NYU Langone Health, New York, New York.
J Arthroplasty. 2024 Sep;39(9S1):S29-S33. doi: 10.1016/j.arth.2024.02.052. Epub 2024 Feb 28.
The impact of increased patient comorbidities on the cost-effectiveness of total hip arthroplasty (THAs) is lacking. This study aimed to compare revenue, costs, and short-term (90 days) surgical outcomes between patients who have and do not have a high comorbidity burden (HCB).
We retrospectively reviewed 14,949 patients who underwent an elective, unilateral THA between 2012 and 2021. Patients were stratified into HCB (Charlson Comorbidity Index ≥ 5 and American Society of Anesthesiology scores of 3 or 4) and non-HCB groups, and were further 1:1 propensity matched based on baseline characteristics. Perioperative data, revenue, costs, and contribution margins (CMs) of the inpatient episode were compared between groups. Also, 90-day readmissions and revisions were compared between groups. Of the 11,717 patients who had available financial data (n = 1,017 HCB, n = 10,700 non-HCB), 1,914 patients were included in the final matched analyses (957 per group).
Total (P < .001) and direct (P < .001) costs were significantly higher for HCB patients. Comparable revenue between cohorts (P = .083) resulted in a significantly decreased CM in the HCB patient group (P < .001). The HCB patients were less likely to be discharged home (P < .001) and had significantly higher 90-day readmission rates (P = .049).
Increased THA costs for HCB patients were not matched by increased revenue, resulting in decreased CM. Higher rates of nonhome discharge and readmissions in the HCB population add to the additional financial burden. Adjustments to the current reimbursement models should better account for the increased financial burden of HCB patients undergoing THA and ensure access to care for all patient populations.
III.
患者合并症增加对全髋关节置换术（THA）成本效益的影响尚不清楚。本研究旨在比较高合并症负担（HCB）患者和无 HCB 患者的收入、成本和短期（90 天）手术结果。
我们回顾性分析了 2012 年至 2021 年间接受择期单侧 THA 的 14949 例患者。患者分为 HCB（Charlson 合并症指数≥5 分和美国麻醉医师协会评分 3 或 4 分）和非 HCB 组，并根据基线特征进行 1:1 倾向匹配。比较两组患者围手术期数据、住院期间的收入、成本和边际贡献（CM）。还比较了两组 90 天再入院和翻修率。在 11717 例有可用财务数据的患者中（n=1017 例 HCB，n=10700 例非 HCB），1914 例患者纳入最终匹配分析（每组 957 例）。
HCB 患者的总（P<0.001）和直接（P<0.001）成本显著更高。两组间收入相当（P=0.083），导致 HCB 患者组的 CM 显著降低（P<0.001）。HCB 患者更不可能出院回家（P<0.001），90 天再入院率显著更高（P=0.049）。
HCB 患者 THA 费用的增加没有得到收入的相应增加，导致 CM 降低。HCB 人群中较高的非出院回家率和再入院率增加了额外的经济负担。调整当前的报销模式应更好地考虑 HCB 患者接受 THA 的额外经济负担，并确保所有患者群体都能获得医疗服务。
III。
