Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
J Arthroplasty. 2024 Sep;39(9S1):S34-S38. doi: 10.1016/j.arth.2024.03.024. Epub 2024 Mar 16.
The clinical impact of the surgical approach in total hip arthroplasty (THA) has been widely reviewed. This study evaluated the total encounter and 90-day costs of THA for 2 surgical approaches (posterior [P] and direct anterior [DA]) in 1 tertiary health system.
This is a retrospective review of 2,101 THAs (1,092 P and 1,009 DA) by 4 surgeons (2 with the highest volume of DA and P, respectively) from 2017 to 2022 at 1 academic center. Demographics, comorbidities, operative time, length of hospital stay, 90-day hospital returns, and complications were compared. The total encounter cost and 90-day postoperative cost were itemized. Multivariable regression analyses evaluated associations with increased cost at each time point.
The DA cohort had a higher median encounter cost ($8,348.66 versus 7,332.42, P < .01), resulting from higher intraoperative (P < .01) and radiology (P < .01) expenses. Regression analyses demonstrated the DA was independently associated with increased encounter costs (odds ratio 1.1; 95% confidence interval 1.1 to 1.1; P < .01). There was a higher incidence of 90-day emergency department visits in the DA cohort (16 versus 12%, P = .02), with a trend toward increased readmissions. There was no difference in 90-day reoperations. Median 90-day cost was higher in the DA cohort ($126.99 versus 0.00, P < .01), and regression analyses demonstrated the DA had an association with increased 90-day cost (odds ratio 2.2; 95% confidence interval 1.5 to 3.0; P < .01).
Despite a younger patient population, the DA was independently associated with increased encounter and 90-day costs in a single academic hospital system. This study may underestimate the cost difference, as capital costs such as specialized tables were not analyzed.
全髋关节置换术（THA）的手术入路的临床影响已被广泛研究。本研究评估了在一个三级医疗系统中，两种手术入路（后入路 [P] 和直接前入路 [DA]）进行 THA 的总就诊和 90 天的成本。
这是对 2017 年至 2022 年间，由 4 名外科医生（分别为 DA 和 P 手术量最高的 2 名）进行的 2101 例 THA（1092 例 P 和 1009 例 DA）的回顾性研究。比较了人口统计学特征、合并症、手术时间、住院时间、90 天内医院复诊情况和并发症。列出了总就诊费用和 90 天术后费用。多变量回归分析评估了每个时间点费用增加的相关性。
DA 组的中位数就诊费用较高（8348.66 美元 vs. 7332.42 美元，P<.01），这是由于术中（P<.01）和影像学（P<.01）费用较高所致。回归分析表明，DA 与就诊费用增加独立相关（比值比 1.1；95%置信区间 1.1 至 1.1；P<.01）。DA 组在 90 天内急诊就诊的发生率较高（16% vs. 12%，P=0.02），再入院率呈上升趋势。90 天内再次手术的发生率无差异。DA 组的中位数 90 天费用较高（126.99 美元 vs. 0.00 美元，P<.01），回归分析表明，DA 与 90 天费用增加有关（比值比 2.2；95%置信区间 1.5 至 3.0；P<.01）。
尽管患者人群更年轻，但在一个单一的学术医院系统中，DA 与就诊和 90 天费用的增加独立相关。本研究可能低估了成本差异，因为未分析特殊手术台等资本成本。
