Department of Orthopaedic Surgery, NYU Langone Health, New York, New York.
Department of Orthopaedic Surgery, NYU Langone Health, New York, New York; Division of Orthopaedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
J Arthroplasty. 2024 Sep;39(9S2):S88-S94. doi: 10.1016/j.arth.2024.04.055. Epub 2024 Apr 25.
Utilization of total knee arthroplasty (TKA) continues to rise among patients who have a high comorbidity burden (HCB). With changes in reimbursement models over the past decade, it is essential to assess the financial impact of HCB TKA on healthcare systems. This study aimed to examine trends in revenue and costs associated with TKA in HCB patients over time.
Of 14,978 TKA performed at a large, urban academic medical center between 2013 and 2021, we retrospectively analyzed HCB patients (Charlson comorbidity index ≥ 5 and American Society of Anesthesiology scores of 3 or 4). A total of 1,156 HCB TKA patients who had complete financial data were identified. Patient demographics, perioperative data, revenue, costs, and contribution margin were collected for each patient. Changes in these financial values over time, as a percentage of 2013 values, were analyzed. Linear regression was performed with a trend analysis to determine significance.
From 2013 to 2021, the percentage of HCB TKAs per year increased from 4.2% in 2013 to 16.5% in 2021 (P < .001). The revenue of TKA in HCB patients remained steady (P = .093), while direct costs increased significantly (32.0%; P = .015), resulting in a decline of contribution margin to a low of 82.3% of 2013 margins. There was no significant change in rates of 90-day complications or home discharge following HCB TKA during the study period.
The results of this study indicate a major rise in cost for TKA among HCB patients, without a corresponding rise in revenue. As more patients who have HCB become candidates for TKA, the negative financial impact on institutions should be considered, as payments to institutions do not adequately reflect patient complexity. A re-evaluation of institutional payments for medically complex TKA patients is warranted to maintain patient access among at-need populations.
患有高合并症负担（HCB）的患者中，全膝关节置换术（TKA）的使用率持续上升。在过去十年中，随着报销模式的变化，评估 HCB TKA 对医疗系统的财务影响至关重要。本研究旨在随着时间的推移，检查与 HCB 患者 TKA 相关的收入和成本趋势。
在一家大型城市学术医疗中心，我们对 2013 年至 2021 年间进行的 14978 例 TKA 进行了回顾性分析，其中分析了 HCB 患者（Charlson 合并症指数≥5 和美国麻醉医师协会评分 3 或 4）。共确定了 1156 例具有完整财务数据的 HCB TKA 患者。为每位患者收集了患者人口统计学、围手术期数据、收入、成本和边际贡献。分析了这些财务值随时间的变化，以 2013 年的值的百分比表示。使用线性回归进行趋势分析以确定显著性。
从 2013 年到 2021 年，每年 HCB TKA 的百分比从 2013 年的 4.2%增加到 2021 年的 16.5%（P<.001）。HCB 患者 TKA 的收入保持稳定（P=0.093），而直接成本显著增加（32.0%；P=0.015），导致边际贡献下降到 2013 年边际贡献的 82.3%。在研究期间，HCB TKA 后 90 天并发症或家庭出院率没有明显变化。
本研究结果表明，HCB 患者 TKA 的成本大幅上升，而收入没有相应增加。随着越来越多患有 HCB 的患者成为 TKA 的候选者，应考虑对机构的负面财务影响，因为机构的付款并不能充分反映患者的复杂性。需要重新评估对医疗复杂 TKA 患者的机构付款，以维持有需要人群的患者通道。
