Orthopedics. 2024 May-Jun;47(3):e151-e156. doi: 10.3928/01477447-20240304-03. Epub 2024 Mar 12.
With pressures to decrease the financial burden of total hip arthroplasty (THA), it is imperative to understand the cost drivers of this procedure. This study evaluated operative and total encounter costs for two surgical approaches to THA-posterior (P) and direct anterior (DA).
A total of 233 THAs (134 P and 99 DA) performed by two fellowship-trained arthroplasty surgeons from 2017 to 2022 were reviewed. Demographics, comorbidities, mobility status, operative time, length of stay, implants used, discharge location, and complications until final follow-up were recorded. Total encounter cost was collected and itemized. Multivariable regression analyses evaluated predictors of cost.
There were differences in age (67 years for DA and 63 years for P; =.03), body mass index (28.0 kg/m for DA and 33.8 kg/m for P; <.01), Elixhauser Comorbidity Index score (4.6 for DA and 5.6 for P; =.04), and operative time (2.1 hours for DA and 1.9 hours for P; <.01) between the two cohorts. The DA cohort trended toward shorter length of stay, with the highest percentage of patients discharged home (86.9%; =.02). The P cohort had the lowest encounter ($9601 for DA and $9100 for P; =.20) and intraoperative (including implant used) ($7268 for DA and $6792 for P; <.01) costs. The DA cohort had a significantly higher cost of radiology during the encounter ($244; <.01). Regression analysis demonstrated that length of stay and DA approach were both predictors of increased encounter cost.
The DA cohort had improved measures of health; however, this approach was associated with a higher operative cost and was predictive of increased encounter cost despite a shorter length of stay. [. 2024;47(3):e151-e156.].
为了降低全髋关节置换术（THA）的经济负担，了解该手术的成本驱动因素至关重要。本研究评估了两种 THA 手术入路（后入路[P]和直接前入路[DA]）的手术和总就诊费用。
回顾了 2017 年至 2022 年间由两位 fellowship 培训的关节置换外科医生进行的 233 例 THA（134 例 P 和 99 例 DA）。记录了患者的人口统计学、合并症、活动能力状态、手术时间、住院时间、使用的植入物、出院地点和最终随访时的并发症。收集并分类了总就诊费用。多变量回归分析评估了成本的预测因素。
两组患者在年龄（DA 组为 67 岁，P 组为 63 岁；<.03）、体重指数（DA 组为 28.0 kg/m，P 组为 33.8 kg/m；<.01）、Elixhauser 合并症指数评分（DA 组为 4.6，P 组为 5.6；<.04）和手术时间（DA 组为 2.1 小时，P 组为 1.9 小时；<.01）方面存在差异。DA 组的住院时间更短，出院回家的患者比例最高（86.9%；<.02）。P 组的总就诊费用（DA 组为 9601 美元，P 组为 9100 美元；<.20）和术中费用（包括植入物使用）（DA 组为 7268 美元，P 组为 6792 美元；<.01）较低。DA 组的就诊期间放射学费用显著更高（244 美元；<.01）。回归分析表明，住院时间和 DA 入路都是总就诊费用增加的预测因素。
DA 组的健康指标有所改善；然而，尽管住院时间较短，该方法与更高的手术费用相关，并且是总就诊费用增加的预测因素。
